Near Adhesion-Free Reconstructive Pelvic Surgery (NARPS)

Near Adhesion-Free Reconstructive Pelvic Surgery (NARPS) is a method of pelvic surgery that limits the formation of new scar tissue.¹ Adhesions are bands of scar tissue that form after surgery. No surgeon can prevent them completely. Careful choices at every step of the operation can still reduce them substantially.

NARPS combines several techniques. The surgeon operates under magnification. The surgeon divides tissue with fine, sharp instruments instead of tearing it apart. The surgeon rinses the peritoneum, the lining of the pelvis, frequently so that it does not dry out. The surgeon controls bleeding carefully (hemostasis). At the end, the surgeon places a barrier over the healing tissue. Each technique targets one cause of scar tissue: tissue drying (desiccation), poor blood flow (ischemia), bleeding, and rough handling of the peritoneum. No single technique explains the result. The benefit comes from consistent use of all of them in every operation.

The 2010 outcomes paper reported three stages of progress across the period 1987 to 2009.¹ Stage one ran from 1987 to 1993 and included 26 patients. Stage two ran from 1994 to 2005 and included 44 patients. Stage three ran from 2006 to 2009 and included 25 patients. The title of the paper describes this span as 23 years. This count includes both the first and the last calendar years, as well as the intervening years.¹

The investigators measured adhesions with the American Fertility Society (AFS) adhesion scoring system. Across all 95 patients, total adnexal scores (for the tubes and ovaries) fell in every stage. They fell from 33.8 to 18.1 in stage one, from 33.3 to 6.0 in stage two, and from 33.2 to 2.5 in stage three.¹ Each decrease within a stage was statistically significant at P<0.001. The comparison between stages used a second look inside the pelvis with a camera (second-look laparoscopy). The improvements from one stage to the next were statistically significant at P<0.01.

NARPS is closely related to pelvic excision and repair surgery. That entry covers the operation performed for a given disease. NARPS covers the way a surgeon carries out the operation. One describes the procedure itself. The other describes how the surgeon protects the tissue afterward.