{"page":"\u003clink rel=\"stylesheet\" href=\"https://lessonplanet.com/assets/packs/css/resources-c03aa079.css\" /\u003e\n\u003clink rel=\"stylesheet\" href=\"https://lessonplanet.com/assets/packs/css/lp_boclips_stylesheets-517835be.css\" media=\"all\" /\u003e\n\u003cdiv data-title='Pioneering surgery for obese people' data-url='/boclips/videos/5c54c525d8eafeecae16e06c' data-video-url='/boclips/videos/5c54c525d8eafeecae16e06c' id='bo_player_modal'\u003e\n\u003cdiv class='boclips-resource-page modal-dialog panel-container'\u003e\n\u003cdiv class='react-notifications-root'\u003e\u003c/div\u003e\n\u003cdiv class='rp-header'\u003e\n\u003cdiv class='rp-type'\u003e\n\u003ci aria-hidden='true' class='fai fa-regular fa-circle-play'\u003e\u003c/i\u003e\nVideo\n\u003c/div\u003e\n\u003ch1 class='rp-title' id='video-title'\u003e\nPioneering surgery for obese people\n\u003c/h1\u003e\n\u003cdiv class='rp-actions'\u003e\n\u003cdiv class='mr-1'\u003e\n\u003ca class=\"btn btn-success\" data-posthog-event=\"Signup: LP Signup Activity\" data-posthog-location=\"body_link_boclips\" data-remote=\"true\" href=\"/subscription/new\"\u003e\u003cspan\u003e\u003cspan\u003eGet Free Access\u003c/span\u003e\u003cspan class=\"\"\u003e for 10 Days\u003c/span\u003e\u003cspan\u003e!\u003c/span\u003e\u003c/span\u003e\u003c/a\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='rp-body'\u003e\n\u003cdiv class='rp-info'\u003e\n\u003cdiv aria-label='Hide resource details' class='rp-hide-info' role='button' tabindex='0'\u003e\u0026times;\u003c/div\u003e\n\u003ci aria-label='Expand resource details' class='rp-expand-info fai fa-solid fa-up-right-and-down-left-from-center' role='button' tabindex='0'\u003e\u003c/i\u003e\n\u003ci aria-label='Compress resource details' class='rp-compress-info fai fa-solid fa-down-left-and-up-right-to-center' role='button' tabindex='0'\u003e\u003c/i\u003e\n\u003cdiv class='rp-rating'\u003e\n\u003cspan class='resource-pool'\u003e\n\u003cspan class='pool-label'\u003ePublisher:\u003c/span\u003e\n\u003cspan class='pool-name'\u003e\n\u003cspan class='text'\u003e\u003ca data-publisher-id=\"30356011\" href=\"/search?publisher_ids%5B%5D=30356011\"\u003eCurated Video\u003c/a\u003e\u003c/span\u003e\n\u003c/span\u003e\n\u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv class='rp-description'\u003e\n\u003cspan class='short-description'\u003eSan Francisco, California, US, March 20, 2009  1. Wide shot University of California San Francisco Hospital 2. Close shot UCSF sign  San Francisco, California, US, March 11, 2009  3. Wide shot Elena McLachlan walking 4. Medium shot...\u003c/span\u003e\n\u003cspan class='full-description hide'\u003eSan Francisco, California, US, March 20, 2009  \u003cbr/\u003e1. Wide shot University of California San Francisco Hospital \u003cbr/\u003e2. Close shot UCSF sign  \u003cbr/\u003eSan Francisco, California, US, March 11, 2009  \u003cbr/\u003e3. Wide shot Elena McLachlan walking \u003cbr/\u003e4. Medium shot McLachlan entering doctoral students' lounge \u003cbr/\u003e5. McLachlan showing food she is giving away to friends before weight loss surgery \u003cbr/\u003e6. Close shot food \u003cbr/\u003e7. SOUNDBITE (English) Elena McLachlan, doctoral student in nursing at UCSF and participant in clinical trial: \u003cbr/\u003e\"I feel like I've already put myself into a mindset that this is going to work and that it's going to be a positive experience and that it's going to be a total lifestyle change. And I'm really looking forward to being able to do more activities that I can't do right now. Like one of my real dreams is to go to Tuscany and be able to like actually climb the hills.\" \u003cbr/\u003e8. UPSOUND (ENGLISH) Elena McLachlan, doctoral nursing student walking around shop, showing and talking about the foods she can't eat \u003cbr/\u003e\"This is where all the chips are, and drinks, and here we have all the delicious desserts, all things that I won't be eating anymore.\" \u003cbr/\u003e9. Close up pan of cakes\u003cbr/\u003e10. Close shot McLachlan hands holding food wrapper and reading the nutritional information  \u003cbr/\u003eSan Francisco, California, US, March 13, 2009  \u003cbr/\u003e11. Doctor walking down hallway at UCSF hospital \u003cbr/\u003e12. SOUNDBITE (English) Dr. Stanley Rogers, surgeon: \u003cbr/\u003e\"This TOGA procedure has shown results that are equivalent to patients having gastric banding surgery for obesity, meaning most patients will lose approximately forty per cent of their excess bodyweight.\" \u003cbr/\u003e13. (MUTE) Full screen computer animation showing TOGA device in action (courtesy UCSF)\u003cbr/\u003e14. SOUNDBITE (English) Doris Labelson, Elena's mother: \u003cbr/\u003e\"Hopefully everything will turn out perfectly, and I'll have my svelte young lady back again.\" \u003cbr/\u003e15. Close shot mother and daughter holding hands \u003cbr/\u003e16. Close side shot Dr. John Cello, surgeon and gastroenterology specialist \u003cbr/\u003e17. Medium shot Doris Labelson watching doctors speak with her daughter \u003cbr/\u003e18. Close shot McLachlan listening to Cello \u003cbr/\u003e19. Medium shot Cello leaving to prepare for surgery \u003cbr/\u003e20.Various close up of TOGA instruments\u003cbr/\u003eSan Francisco, Calif. - March 20, 2009\u003cbr/\u003e21. Dr. Paul T. Cirangle entering his office \u003cbr/\u003e22. SOUNDBITE (English) Dr. Paul T. Cirangle, bariatric surgeon: \u003cbr/\u003e\"Gastroplasties, or changing the shape or configuration of the stomach, have been done for a long time. It's never been done through the mouth, without an incision in the abdominal wall.\" \u003cbr/\u003e23. Medium shot Cirangle at computer \u003cbr/\u003e24. Close shot hand on computer mouse \u003cbr/\u003e25. SOUNDBITE (English) Dr. Paul T. Cirangle, bariatric surgeon: \u003cbr/\u003e\"They've done the original pilot study in non-US patients and that has demonstrated about a 20 to 30 percent excess weight loss. The issue that they found in that trial was potentially a problem with durability. In other words, this device staples the stomach from the inside, and about 20 to 25 percent of those staple lines had been disrupted because the technology is still new and being developed and refined. So the issue for me is, A is it durable, B how much of a weight loss does it produce, and C who are the patients who can really benefit from this approach?.\"  \u003cbr/\u003e26. Wide shot operating room \u003cbr/\u003e27. Close shot McLachlan's face as she is being prepared for the procedure\u003cbr/\u003eSan Francisco, Calif. - March 20, 2009 \u003cbr/\u003e28. Wide shot California Pacific Medical Centre \u003cbr/\u003e29. Tara Griffith, therapist, speaking with nutritionist \u003cbr/\u003e30. SOUNDBITE (English) Tara Griffith, therapist at Laparoscopic Associates of San Francisco: \u003cbr/\u003e\"The surgery will change your tummy but it won't change your brain. So I do a lot of work with people on changing behaviours, changing habits, realising the reasons why they're eating. You know, what's behind it - was it a stressful day, is it just a habit? Are there some deeper issues that need to be solved? Are you protecting yourself in some way with food? So those are all issues that come up.\" \u003cbr/\u003eSan Francisco, California, US, March 13, 2009  \u003cbr/\u003e31. Doctors in theatre using camera to enter stomach area \u003cbr/\u003e32. Close shot Dr. John Cello \u003cbr/\u003e33. Various operating room  \u003cbr/\u003eA new surgical procedure could offer hope for obese people who find it difficult to  lose weight.\u003cbr/\u003eKnown as TOGA (Trans Oral Gastroplasty) doctors can staple patients' stomachs without making cuts and incisions, which can cause scarring. \u003cbr/\u003eBut some are concerned that surgery isn't the answer to a healthier way of life.\u003cbr/\u003eMany obese people suffer poor health, and are often incapable of leading a normal active life. \u003cbr/\u003eAnd most will, at some stage, have tried anything which claims to offer a solution, from appetite suppressing pills to the latest diet craze. \u003cbr/\u003eBut when these apparent \"cures\" persistently fail, the people that can afford it turn to gastric surgery to help limit the amount of food they can ingest.  \u003cbr/\u003eMany methods exist, including the gastric bypass, which is among the most complicated because it involves creating a stomach pouch out of a small portion of the stomach, attaching it directly to the small intestine, thus bypassing a large part of the stomach and duodenum. \u003cbr/\u003eNot only is the stomach pouch too small to hold large amounts of food, but by skipping the duodenum, fat absorption is substantially reduced. \u003cbr/\u003eThere is also adjustable gastric banding, and the duodenal switch. \u003cbr/\u003eBut if it becomes a success, the Trans Oral Gastroplasty, or TOGA, procedure will be the first to change the shape of the stomach to reduce appetite without making any incisions. \u003cbr/\u003eThis is what has attracted Elena McLachlan. \u003cbr/\u003eShe was very thin as a child but gained weight in her thirties when she was trying to get pregnant. \u003cbr/\u003eMcLachlan, now weighing 242 pounds (109.7 kilograms), volunteered to be part of the TOGA clinical trial with dreams of becoming slim and active again. \u003cbr/\u003eShe's giving away the food she says she'll no longer be able to eat, and she says what she'll miss most is pasta, including her favourite: four cheese macaroni.  \u003cbr/\u003eMcLachlan's mother, Doris Labelson, came from Los Angeles to be with her daughter during the procedure. \u003cbr/\u003eShe says she's nervous but hopes that her daughter will be slim again.  \u003cbr/\u003eSurgeon Dr Stanley Rodgers is confident about TOGA despite the fact that it has not yet received approval from America's Food and Drug Administration (FDA). \u003cbr/\u003eRodgers claims TOGA has the same results as gastric banding surgery for obesity, meaning most patients will lose approximately forty per cent of their excess bodyweight.\u003cbr/\u003eDr. Paul T. Cirangle of Laparoscopic Associates of San Francisco thinks TOGA may be more palatable to patients who are interested in gastric surgery concerned about having incisions in their abdomen.  \u003cbr/\u003eBut Dr. Cirangle, who performs gastric surgeries on hundreds of patients per year, says the TOGA device's method of using suction to fire staples from within the stomach has not yet been perfected, and he is sceptical about the new device's effectiveness. \u003cbr/\u003eHe says a pilot study on non-US patients demonstrated about a 20 to 30 percent excess weight loss.\u003cbr/\u003eDuring the trials, according to Cirangle, there was a problem with the staple method because about a quarter of the staple lines failed to hold. This, he says, is because the technology is still new and needs to be refined. \u003cbr/\u003eTherapist Tara Griffith, who helps prepare patients emotionally for gastric surgery and works with them later in a support group, cautions that any form of banding, whether it's invasive, or not, is not an automatic panacea for obese people. \u003cbr/\u003eShe says there will still be deeper psychological problems to solve including the need for people to understand why they eat too much and why they have a food disorder.\u003cbr/\u003eIn the operating room  McLachlan becomes one of 275 people taking part in the current trial. \u003cbr/\u003eAll those taking part are aged between 18 and 60 and are at least 100 pounds (45.3 kilograms) overweight. \u003cbr/\u003eDuring the new procedure a flexible instrument is inserted into the mouth down to the stomach. \u003cbr/\u003eWith the help of an endoscopic camera that projects an image onto monitors, the doctors use the tip to insert staples and create a small pouch in the stomach. \u003cbr/\u003eThis makes patients feel full after eating just a few bites of food. \u003cbr/\u003eThe University of California San Francisco (UCSF)  is one of nine US hospitals taking part in the clinical trials for the US Food and Drug Administration. The Administration will make the final decision over whether TOGA should be available as a treatment. \u003cbr/\u003eTwo-thirds of the patients participating in the trial are receiving the full operation while the remaining third receive a control procedure. \u003cbr/\u003eAll of them will undergo a strict nutritional program for one year, after which they will be told whether they received the real or control procedure. \u003cbr/\u003eIf control patients haven't lost the desired weight and still meet the original criteria  they may be given the TOGA operation.   \u003cbr/\u003eNOTE: The TOGA clinical trial involving Elena McLachlan is still ongoing.\u003cbr/\u003e\u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv class='action-container flex justify-between'\u003e\n\u003cbutton aria-expanded='false' aria-label='Read more description' class='rp-full-description' type='button'\u003e\n\u003ci class='fai fa-solid fa-align-left'\u003e\u003c/i\u003e\n\u003cspan id='read_more'\u003eRead 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