Endoscopic Revision (ROSE Procedure)

What is a ROSE Procedure?

An innovative procedure now allows surgeons to repair stomach anatomy without any incisions. Your doctor may refer to this as a “ROSE” Procedure, which stands for Repair of Surgery Endolumenal (also referred to as transoral surgery) or Revision obesity surgery Endolumenal.  Surgeons perform a ROSE Procedure using endoscopic surgical tools that make up the Incisionless Operating Platform.   This innovative technique is used to make an enlarged gastric bypass pouch smaller to facilitate further weight loss in situations when a patients has ha inadequate weightless or weight regain after gastric bypass surgery.  In the past the only option for patients was to surgically reduce the size of the pouch and surgical revision of the gastric bypass anastomosis.

Why would my pouch and/or stoma stretch after Gastric Bypass Surgery?

Gastric Bypass surgery reduces the stomach to approximately the size of a golf ball.  During the procedure, the surgeon creates an outlet referred to as a stoma that serves to slow the passage of food from the newly formed stomach pouch that creates a feeling of fullness after a small volume of food is eaten.  Approximately, 20-40% of Gastric Bypass patients may experience the stretching of their pouch and stoma. When the stomach pouch and stoma enlarge, the feeling of fullness may decrease and patients can eat larger meals.  The reasons that the stomach pouch and stoma stretch are not well understood but are unavoidable in the majority of cases..

How is a ROSE Procedure performed?

A ROSE Procedure is performed using a small flexible endoscope for visualization and surgical instruments.  The endoscope and instruments are inserted through the mouth and into the stomach and manipulated using the Transport.  Tissue anchors  are then used to create folds in the gastric tissue tightening areas of the stomach and/or stoma.  This is done with the G-cath and G-prox devices.  With this procedure, no external incisions are made into the skin and patients usually go home the same day.

Rose Procedure from Midtown Surgical on Vimeo.



What are tissue anchors? Will they stay in place?

The expandable tissue anchors are a suturing technology designed to provide a durable option for patients needing a repair procedure in the stomach. These anchors are mostly constructed of polyester suture and durable polyester baskets that expand and hold tissue together. Expandable tissue anchors accommodate different tissue thicknesses that can vary from patient to patient and hold tissue together during the healing process.   In a recent study, it was reported that 92% of 12 month EGDs (endoscopic examination of the stomach after a ROSE Procedure) revealed the continued presence of anchors confirming their durability.

Am I eligible for a ROSE Procedure?

Most patients who have had a previous gastric bypass who have experienced inadequate weightless or weight regain are generally candidates for this procedure.  After an upper endoscopy to evaluate the size and anatomy of the pouch your surgeon can then determine what might be the best option for you.

What can I expect after a ROSE Procedure?

Most patients experience a temporary sore throat but otherwise typically report little or no discomfort after a ROSE procedure. Patients typically return to normal activities within a day or so.  Most patents have a noticeable reduction in their hunger and size of meals.  When this added restriction (smaller meals) is combined with healthy food choices and exercise weight loss usually is quite good.

Will the ROSE Procedure be covered by insurance?

As with any procedure, coverage will vary depending upon the insurance provider. A specialist in your doctor’s office will discuss your plan with you. In the event insurance will not cover the procedure, financing options are available.  In our experience we have been successful in most cases in securing prior approval from most insurance companies.