endoscopic surgery

GLP-1’s Aren’t the Complete Answer

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity, technology , , ,

A recent article from Denmark reported a nationwide cohort study of first time registry based discontinuance rate of 49% for first time GLP-1 users.[i] This clearly indicates that current GLP-1 drugs alone are not a panacea for the obesity problem.  Efforts must be done to insure compliance and continuance by the patients for whom they are prescribed, especially in the young.  Furthermore, some kind of follow-up or follow-on procedure for who encounter the drugs complications or side effects are required to keep them from regaining the lost weight.

Dr. Cucin proposed as early as August 2009 that removing the mesenteric fat which secreted noxious cytokines such as resistin, angiotensin and the interleukins which caused type 2 diabetes, hypertension, strokes, heart attacks, autoimmune diseases, and cancers, respectively would result in an immediate improvement of the patient’s metabolism and relief of metabolic syndrome to the degree this noxious cytokine factory was removed.[ii] Based on the overwhelming studies in lower mammals which provided a strong basis for the belief, BioSculpture Technology adapted its twin cannula assisted liposuction (TCAL) device for the strict (closed) laparoscopic removal of mesenteric fat in an endoscopic visceral lipectomy (EVL®) procedure.

Proof of concept has subsequently been provided with an alternate technology[iii] which requires a midline incision and sequential exenteration of sequential small segments of the small bowel of which the mesentery is to be de-fatted.  The heated saline, high pressure device does not allow a strictly laparoscopic procedure and an average of only 386 ml. of mesenteric fat was removed.  But the improvement in 7 of the 11 patients who completed a clinical trial was conclusive proof that removal of mesenteric fat alleviates metabolic syndrome. 

Although tissue liquefaction required bowel exenteration and midline incisions, the development of coaxial Twin Cannula-Assisted Liposuction (TCAL) removes this surgical barrier. With its stationary protective outer shield, TCAL enables closed peritoneal laparoscopic mesenteric de-fatting, eliminating extensive bowel handling and its associated risks of adynamic ileus and adhesions. This milestone technology enables EVL® to provide a potentially safe, highly effective, and anatomically preserving bariatric intervention to achieve a long-term metabolic cure. Studies are indicated to document its safety and efficacy and investigate whether it lives up to its potential. [iv]

[i]  Mailhac A, Pedersen L, Peterson I, etal. Discontinuance of Samaglutide Therapy for Obesity Management.    JAMA Network Open. 2026;9(8):e2631371. doi:10.1001/jamanetworkopen.2026.31371 (Reprinted)

[ii] Cucin RL. Method of and Apparatus for Treating Abdominal Obesity and Metabolic Syndrome in Human Patients.     U.S. Patent No. 8,348,929 B2. Filed August 5, 2009; Issued January 8, 2013.

[iii] Baskoy G, Peterson RM, Kempenich J et al. Mesenteric Visceral Lilpectomy Improves Glucose Tolerance in Patients with Type 2 Diabetes: A Pilot study.  J Clin Endocrinol & Metab 2025: 110, e3070–e3077 https://doi.org/10.1210/clinem/dgae872

[iv] Cucin, RL A Paradign Shift in Metaboli Surgery: Targeted source Removal via Endoscopic Visceral Lipectomy Arch Metabolic Synd (2026) 6(2):4

BioSculpture Tech. selected for Inclusion in the 2026 Yale Innovation Summit.

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity, technology, Uncategorized , , , ,

The Company will appear in the Virtual Showcase to highlight our treatment innovations to 2,500+ attendees including investors, researchers, other founders, and potential partners through the Summit’s digital platform. The 2026 Innovation Summit is hosted by Yale University in New Haven, Connecticut on May 27-28, 2026.

CDC Reports the U.S. is Supersized

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity, technology , , ,

A black and white picture of the airbrush logo.The CDC reports that 7 out of 10 Americans are overweight or obese and almost 4 out of 10 Americans are obese.

There is an underlying pattern of racial and ethnic disparity.  Almost half of Hispanics and blacks are obese with obesity rates for 2015-2016 of 47% and 46.8% for adult Latinos and non-Hispanic blacks respectively.

Obesity is most readily defined by Body Mass Index (“BMI”) which takes a person’s weight in kilograms and divides it by their height in meters squared.  For adults, those with a BMI between 18.5 and 24.9 are considered to have a normal weight. A BMI between 25 and 29.9 is considered overweight and anything above 30 is deemed obese.  The NIH provides a calculator for you to determine your own BMI.

It is apparent to anyone following these statistics or even just walking down the street that current efforts to control the obesity problem have failed to reduce obesity rates.

We have learned that visceral fat or “belly” fat within the abdomen hijacks the metabolism by secreting the cytokine resistin.  This cellular hormone antagonizes insulin, blocking sugar from entering cells or reaching the brain.  It saps energy, shuts down the metabolism, causes brain fog, and hunger. Cellular hormones are secreted directly into the portal circulation and the body’s protein factory, the liver, is commandeered to produce bad lipids which cause strokes and heart attacks. Mesenteric fat thickness is closely correlated with carotid intimal narrowing.  Belly fat doesn’t just shorten your life, it reduces its quality with sleep apnea, gastric reflux, type 2 Diabetes mellitus, heart attacks, strokes, autoimmune diseases, and cancers.

New technology facilitates a new approach to the problem. Rather than just starving this belly fat and letting it remain in place as do current bariatric surgical alternatives, removing it this visceral fat in aminimally invasive procedure may prove to be a simpler, more direct and permanent, safer and highly effective alternative.  Endoscopic visceral lipectomy could just be what the doctor ordered.  Â It is clearly time to seek new approaches and fresh solutions as obesity rates continue to rise.