Natural orifice translumenal endoscopic surgery (NOTES)

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Editor-In-Chief: Mohammed A. Sbeih, M.D. [1]

Related Key Words and Synonyms: Natural orifice translumenal endoscopic surgery, single incision laparoscopic surgery, minimally invasive surgery, transanal endoscopic microsurgery.

Overview

Natural orifice translumenal endoscopic surgery (NOTES) is an experimental surgical technique whereby "scarless" abdominal operations can be performed. The surgeon accesses the peritoneal cavity or the thoracic cavity via a hollow viscus and performs diagnostic or therapeutic procedures. NOTES involves passing surgical instruments and a tiny camera through a natural orifice (mouth, urethra, anus, etc.), then the procedure can be performed through an internal incision in the stomach, vagina, bladder or colon, thus avoiding scars and external incisions through the skin, muscles, and nerves. The patients recover more quickly and experience less pain with better cosmetic results. The postoperative complications such as wound infections and hernias are significantly reduced.

Animal models and cadavers have been used to demonstrate the possible applications of NOTES, including abdominal cavity screening, abdominal organs biopsy, appendectomy, cholecystectomy, tubal ligation, gastrojejunostomy, partial hysterectomy, oophorectomy, colorectal resection and trans-esophageal myotomy.

Historical Perspective

• Dimitri Ott from Russia performed transvaginal inspection of the peritoneal cavity in 1901.

• Laparoscopic surgery innovation was introduced in the late 1980s, and the minimally invasive surgery started spreading worldwide

in 1987, when the first laparoscopic cholecystectomy was performed by Dr. Philippe Mouret Spaner .

• The first reported human transgastric endoscopic appendectomy was in India in 2004 (by G.V. Rao and N. Reddy).

• NOTES was originally described in animals by researchers at Johns Hopkins University (Dr. Anthony Kalloo et al.).

• Senior leadership from the American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) organized a working group of surgeons and gastroenterologists in 2006 to develop standards for the practice of NOTES. This group is known as the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) .

• EURO-NOTES Foundation, established in 2006 in cooperation between European Asociation for Endoscopic Surgery (EAES) and the European Society of Gastrointestinal Endoscopy (ESGE) to focus on all activities regarding Natural Orifice Transluminal Endoscopic Surgery (NOTES). The first meeting was in June 23, 2006 in Berlin/Germany.

• Radical sigmoidectomy using a pure NOTES transanal approach was first described in 3 human cadavers in 2007 by Whiteford et al who used TEM as an endoscopic platform without the need for any abdominal incisions .

• On June 25, 2007 Swanstrom and colleagues reported the first human transgastric cholecystectomy .

• In early March 2007, the NOTES Research Group in Rio de Janeiro/Brazil, led by Dr. Ricardo Zorron, performed the first series of transvaginal NOTES cholecystectomy in four patients, based in previous experimental studies. The first human transvaginal endoscopic cholecystectomy case was reported in 2007 .

• In late 2008 surgeons from Johns Hopkins School of Medicine removed a healthy kidney from a woman donor using NOTES. The surgery was called transvaginal donor kidney extraction .

• The first clinical case of a NOTES transanal resection for rectal cancer using TEM and laparoscopic assistance was performed at the Hospital Clinic in Barcelona by a team of surgeons from the Hospital Clinic in Barcelona and Massachusetts General Hospital in Boston in November 2009 .

What has been achieved so far?

• Laboratory Reports
• Human Cases

Potential Applications

• Transvaginal NOTES
• Transrectal NOTES
• Transgastric NOTES
• Transesophagea NOTES
• Transurethral/Transcystic NOTES

External links

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