In the last several years, UCSD's successes with NOTES have been featured in national newspapers and magazines. Even Hollywood called to incorporate the scarless surgery in an episode of "ER" he says smiling.
Although they've come very far in the four years of the operation, Horgan acknowledges that significant challenges remain.
The field needs better tools that allow greater flexibility for surgeons to close incisions inside the body after the diseased or unwanted tissue has been removed. That requires venture capital investment that has been lacking during this recession, Horgan says.
And there remains a question about whether surgeons outside of an academic center or hospital specializing in such procedures can perform these operations with equal success, working with cameras and mirrors inside the body.
"A big challenge is in the training. We are much more careful today in terms of making sure that the patient doesn't get the learning curve when we operate," Horgan says.
The national clinical trial, Natural Orifice Surgery Consortium for Assessment and Research, is a joint venture between the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons. NOSCAR also is financially supported by a variety of endoscopic equipment manufacturers.
To help doctors learn the technique, UC San Diego is building the Center for the Future of Surgery on the La Jolla medical school campus, where physicians from around the world can learn NOTES tools and techniques.
Horgan acknowledges that many surgeons, including his father who is a surgeon in Argentina, have been skeptical.
"My father was a surgeon who said, 'The bigger the scar, the better the surgeon.' Well that's not true anymore. We are making almost no incisions and the operations are better."
Now, even his father is impressed, Horgan says. "He never thought it would get this far. He is amazed."