The TOGA Procedure (Transoral Gastroplasty)

[MsJacquiiC]

The TOGA Procedure
Transoral Gastroplasty

The TOGA procedure is an incision-free treatment using a set of flexible staplers introduced into the mouth and esophagus to create a sleeve in the stomach.

The Transoral Gastroplasty, or TOGA ? for short (translated “stomach surgery through the mouth”), is a new approach to weight loss surgery that eliminates the need for abdominal incisions. Instead of entering the stomach through the abdomen, as with most bariatric procedures, the TOGA procedure goes in through the mouth.

The TOGA? System is not yet available for widespread use, but is currently the focus of a multi-center study in the United States for the purpose of gaining FDA approval.

About TOGA

The company behind the TOGA? System is Satiety, Inc., a medical device company that is developing technologies to provide obese patients with less invasive treatment options.

With this system, the procedure is performed endoscopically (through the mouth) and therefore considered “non-surgical” as it does not involve either conventional open surgery or laparoscopic surgery. A set of flexible devices is inserted through the mouth into the stomach in order to staple together sections of the stomach and thus reduce it’s overall food capacity, limiting the amount of food that can be eaten and gives the patient a feeling of fullness after a small meal.

The procedure can be performed by bariatric surgeons, general endoscopic surgeons, and gastroenterologists who have been properly trained to use the TOGA? System.

The TOGA? System is less invasive than other bariatric procedures, because it is performed through the mouth and does not require any surgical incisions.

The Method - Stomach Stapling Without Surgery

The TOGA? System is a set of flexible stapling devices that is inserted through the mouth into the stomach. Once the device is in place, suction is used to gather together tissue from both sides of the stomach into the device. The collected tissue is then fastened together with titanium staples. The procedure creates a small stomach pouch, shaped like a narrow sleeve, at the top of the stomach. Once the stomach is stapled and the procedure is complete, the device is removed from the body.

Results - How it Promotes Weight Loss

The TOGA? System creates a small stomach pouch, shaped like a sleeve, to catch food as it enters the stomach.

The TOGA? System creates a small stomach pouch at the stomach entry, which catches food as it enters the stomach. This slows the movement of food and gives patients a feeling of fullness after eating only a small meal. The overall effect is to help patients feel full faster and eat smaller portions. It is designed to achieve weight loss similar to other restrictive bariatric surgeries.

Benefits of the TOGA System

The TOGA? System is less invasive than other bariatric procedures, because it is performed through the mouth and does not require any surgical incisions. This allows for a quicker recovery and shorter healing time. Also, since it does not use an implant, such as a gastric band, it does not have the associated implant problems.

The TOGA System:

• is incision-free
• does not use an implant
• does not involve intestinal cutting or rerouting
• is less invasive, requires less recovery time, and should cause less complications than other bariatric procedures
• is designed to achieve weight loss similar to other restrictive surgeries

Steps of the TOGA Procedure

• Step 1
  With the patient under general anesthesia, the TOGA Sleeve Stapler is inserted through the mouth into the stomach
  
• Step 2
  The stomach tissue is spread and positioned using a retraction device
  
• Step 3
  (Endoscopic View) Applying suction, tissue from the anterior and posterior of the stomach is collected into the device
  
• Step 4
  (Endoscopic View) The device is closed, and titanium staples are delivered
  
• Step 5
  This creates a sleeve at the entry of the stomach, along the lesser curve
  
• Step 6
  The TOGA Restrictor is inserted, and is used to narrow the bottom of the sleeve
  
• Step 7
  The resulting pouch is designed to collect food as it enters the stomach, giving patients a feeling of fullness after a small meal.

The TOGA US Clinical Trial

The TOGA? System is currently in the investigational stage in the United States. The purpose of the study is to evaluate the safety and effectiveness of the procedure for the treatment of morbid obesity. The title of the study is: Pivotal Clinical Study - TOGA?: A Randomized, Sham-Controlled Trial to Assess the Safety and Effectiveness of Transoral Gastroplasty in the Treatment of Morbid Obesity.

The TOGA Procedure Video:

Morbid Obesity A condition in which the Body Mass Index is 40.0–49.9, which is roughly equal to 100 pounds or more over ideal body weight; a weight level that is life-threatening. A BMI greater than 50 is termed as "super obese." CLICK HERE TO OPEN THE JOURNEY BMI CALCULATOR!

Bariatrics The branch of medicine that deals with the causes, prevention, and treatment of obesity. The term bariatrics was created around 1965, from the Greek root baro ("weight," as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). Besides the pharmacotherapy of obesity, it is concerned with obesity surgery.

Laparoscopy Laparoscopic surgery, also called minimally invasive surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions as compared to larger incisions needed in open surgical procedures. Laparoscopic surgery belongs to the broader field of endoscopy. The key element in laparoscopic surgery is the use of a laparoscope: a telescopic rod lens system, that is usually connected to a video camera. Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm Trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system.

Obesity Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk. CLICK HERE TO OPEN THE JOURNEY BMI CALCULATOR!

Gastric Banding Surgery The adjustable gastric banding is a restrictive surgical procedure during which a silicone band is placed around the stomach, creating a small pouch. The band includes a balloon that is filled with a nontoxic fluid, most commonly a saline solution; periodic adjustments are performed by a healthcare professional who accesses the balloon via a subcutaneous port. Gastric band placement, unlike malabsorptive weight loss surgery (e.g. Roux-en-Y gastric bypass surgery, Biliopancreatic Diversion, and Duodenal Switch), does not cut or remove any part of the digestive system. See WLS Videos for animated surgery technique.

Surgical Staples Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds. Stapling is much faster than suturing by hand, and also more accurate and consistent. In bariatric surgery, staples are primarily used because staple lines are less likely to leak blood, air or bowel contents. In skin closure, dermal adhesives (skin glues) are also an increasingly common alternative. The technique of stapling for surgery is said to have been influenced by the Roman use of ants for wound closure.

Endoscopy Endoscopy is a minimally invasive medical procedure that is used to assess the interior surfaces of an organ by inserting a tube (generally a medical instrument known as an endoscope) into the body. Many endoscopic procedures are considered to be relatively painless and, at worst, associated with mild discomfort. Eliminating incisions means less risk than traditional open or laparoscopic surgery, minimal post operative pain, fast recovery time and no scarring. The Restorative Obesity Surgery, Endolumenal Procedure better known as The ROSE Procedure is performed endoscopically, as is the StomaphyX gastric bypass revision. Patients generally report minimal or no pain after the procedures and many of them return to work and normal activities the next day.

Gastroplasty Any surgical treatment of the stomach or lower esophagus used to decrease the size of the stomach. The procedure is used mainly in the treatment of morbid obesity and to correct defects in the lower esophagus or the stomach.

Pouch Most bariatric surgeries restricts the amount of food a patient can eat by reducing the size of the stomach by gastric banding, stapling or removal. What results is known as the gastric pouch.

The TOGA Procedure The Transoral Gastroplasty, or TOGA ? for short, is a new approach to weight loss surgery that eliminates the need for abdominal incisions. Instead of entering the stomach through the abdomen, as with most bariatric procedures, the TOGA procedure goes in through the mouth. Is performed without surgical incisions using a flexible device that is passed through the mouth and down to the stomach. The device is used to create a small pouch, which is intended to give patients a feeling of fullness after a small meal. See our in-depth TOGA procedure article, including animation video, in the forums.