What is the ROSE PROCEDURE? Endoscopic (Incision-less) procedure
The ROSE procedure is indicated for gastric bypass patients who were initially successful in losing the excess weight but are now regaining some of the lost weight because the stomach and stoma have stretched out and no longer effectively control hunger and food intake.
New surgical tools now allow surgeons to reduce the size of the pouch and stoma through the patient's mouth without making external cuts into the body.  Your doctor may refer to this as the "ROSE" procedure, which stands for Restorative Obesity Surgery, Endoscopic.

Before the ROSE incisionless procedure, patients who regained weight after gastric bypass generally had few treatment options.  Scarring and adhesions related to the initial bypass procedure make open or laparoscopic revision surgery very challenging.  Revision surgery procedure time is typically longer than the original bypass procedure and patients can be up to three times more likely to develop a complication following revision surgery.  Therefore, most patients who regain weight after gastric bypass opt not to undergo open or laparoscopic surgical revision after weighing the risks and benefits.  

Why would I gain weight after gastric bypass?
A number of studies suggest that patients regain weight due to the gradual enlargement of the surgically altered small stomach pouch and stoma, (connection between the stomach and small intestine).  When the Roux-en-Y procedure is performed, the stomach and stoma are made very small, which slows the passage of food and creates a feeling of fullness after just a small volume of food is eaten.  It is believed that when the stomach pouch and stoma gradually enlarge, the feeling of fullness is no longer present, patients can eat larger meals, and weight regain occurs.

How do I find out if I'm eligible for this new incisionless, restorative ROSE procedure? 
Patients who had a Roux-en-Y gastric bypass more than 2 years ago, lost over 50% of their excess weight and have now regained 15% or more of this weight are ideal candidates for this procedure.  

After an initial screening, you will undergo a series of evaluations including nutritional and dietary counseling, a full medical exam and endoscopy to determine if you are a good candidate. 

What does the ROSE procedure entail?
The ROSE procedure is performed using a small flexible endoscope and a new EndoSurgical Operating System (EOS).  The scope and the EOS instruments are inserted through the mouth into the stomach pouch the same way as a standard endoscope.  Tissue anchors are used to create multiple, circumferential tissue folds around the stoma to reduce the diameter, typically to about 10mm.  The surgeon will then use the same technique to place anchors in the stomach pouch to reduce its volume capacity.  After the procedure the patient will enter the institution's standard bariatric surgery follow-up program of nutritional counseling and exercise, similar to the one prescribed after their original gastric bypass surgery. 

What instruments are used?
The ROSE procedure is performed with a new EndoSurgical Operating System (EOS) and a small flexible endoscope for visualization.  The EOS consists of a long narrow access platform called the TransPort and specialized surgical tools (that grab tissue, hold it in place and insert anchors and sutures), all of which are cleared by the U.S. Food and Drug Administration (FDA). 

he surgeon easily advances the TransPort into the GI tract in its flexible state, guided by the camera and light in the endoscope that's inserted into one of its four working channels.  With a squeeze of the handle, the TransPort locks into place, conforming to the patient's unique anatomy.  Once locked in place, the surgeon can advance the different surgical tools through its remaining three channels and then steer the end of the device freely to visualize a site and operate with efficiency and precision. The TransPort allows the surgeon use both hands to manipulate and view tissue.

Where will the procedure be performed?
The ROSE procedure may be performed in a Hospital Operating Room, an Outpatient Surgery Center or an Endoscopy Suite.  Your doctor will choose the location that is best for you and his surgical team.  

How long will I need to stay in the hospital?
Typically, patients stay less than 23 hours.  You may be discharged the same day if the procedure was done early in the morning, or you may stay overnight.  Your surgeon will make the determination following your procedure. 

What are the benefits of an incisionless procedure?
By eliminating skin incisions, this new procedure may provide important advantages to patients, including, reduced risk of infection and associated complications, less post-operative pain, faster recovery time, and no abdominal scars. 

What type of side effects can I expect?
It is anticipated that patients will feel little or no discomfort from the procedure.  To date, the only noted side effects have been short-term sore throat, swollen tongue and lip pain from the insertion of the instruments into the mouth. 

Is it safe?
As with any surgery there is risk involved.  This less invasive approach should reduce the likelihood of many of the complications associated with the open or laparoscopic revision surgery.   

What is the recovery process?
Typically patients return to normal activity within a few days of their procedure.  Your doctor will give you specific instructions.  In addition, patients are asked to follow a post bariatric surgery diet and exercise plan, similar to the regimen prescribed following the initial bypass surgery.  In addition, follow-up appointments with your doctor and regular visits with bariatric support staff will be required.  

Will it be covered by insurance?
As with gastric bypass surgery, coverage will vary depending upon the insurance provider.  A specialist in your physician's office will discuss your plan with you.  In the event insurance will not cover the procedure, financing options may be available.  Check with your surgeon’s office for information on possible financing programs as well as potential tax advantages for any expenses you may incur.  

What will the procedure cost?
The cost for the procedure will vary depending upon where the procedure is performed, how long you stay in the facility and other factors.  Your doctor or the program coordinator will be able to give you an estimate of the total cost.    

Is incisionless surgery just for gastric bypass restorations?
This procedure is one of the first of many potential applications for Incisionless Surgery.  Incisionless Surgery is considered the next wave in minimally invasive procedures and, in addition to obesity, it has generated interest among physicians in areas such as GERD, GI cancer and NOTES (Natural Orifice Translumenal Endoscopic Surgery).

Endoscopic Revision for Gastric Bypass - "ROSE  PROCEDURE"

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