Natural orifice translumenal endoscopic surgery (NOTES): Difference between revisions
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==[[Natural orifice translumenal endoscopic surgery (NOTES) challenges and drawbacks|Current Challenges and Drawbacks to Clinical Application of NOTES]]== | ==[[Natural orifice translumenal endoscopic surgery (NOTES) challenges and drawbacks|Current Challenges and Drawbacks to Clinical Application of NOTES]]== | ||
==[[Natural orifice translumenal endoscopic surgery (NOTES) human experience|Human Experience]]== | ==[[Natural orifice translumenal endoscopic surgery (NOTES) human experience|Human Experience]]== | ||
Revision as of 01:25, 7 March 2012
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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, Natural Orifice Surgery Consortium for Assessment and Research.
Overview
Historical Perspective
Experimental Evolution
Advantages Over Current Surgical Techniques
What has been achieved so far?
Current Challenges and Drawbacks to Clinical Application of NOTES
Human Experience
There are hundreds of human cases have been reported since the first human NOTES case in India in 2003 [1]. Drs. G.V. Rao and D.N. Reddy performed transgastric appendectomy at the Asian Institute of Gastroenterology in Hyderbad, India in 2003. This was a heady experience in the NOTES field.
More than 500 cases have been reported in Germany and more than 300 cases have been reported in Brazil [2][3]. Many human cases have been reported in the United States and in other countries. Most of the reported cases are not purely NOTES but with laparoscopic assistance. A few number of the reported cases are pure NOTES procedures.
Another heady human experience was performing a NOTES procedure outside the operating room (in the bedside) by Marks et al . The procedure was a transgastric retrieval of a dislodged gastrostomy tube [4].
Potential Applications
NOTES procedures have been performed through different natural orifices. So far, transvaginal approach is the most commonly used and has the highest success rate for certain procedures.
Transvaginal NOTES
This is the most common apprach to be used in NOTES procedures. This approach has been used for cholecystectomy, appendectomy, colon resections, abdominal wall hernia repair, and sleeve gastrectomy [3]. Transvaginal fertility procedures and oocytes procurement transvaginally has been performed for years [5]. Transvaginal cholecystectomy and transvaginal appendectomy have been performed in humans. Around 85% of the Notes procedures that have been reported in Germany is transvaginal cholecystectomy (the most common) [2]. There are many advantages for this approach which include:
- The organ (Gallbladder, appendix or others) can be extracted easily outside the body through the flexible walls of the vagina even the large organs.
- It is relatively easier and safer to perform the procedure through this approach. Vaginal wall closure is less complex than gastric wall closure and has less complications rate [6]. A single stitch can be easily used to close the incision.
- In general, transvaginal NOTES has lower complications rates than other approaches.
- Transvaginal rout is considered the best rout for performing minor uterine procedures for benign uterine diseases [7].
- Sexual function is not affected by transvaginal extraction of the uterus or other organs [8].
The drawback of this approach is that it can be used only in females. Also, the NOTES surgeon should have the basics of gynecological surgery before perform a transvaginal procedure. Women may present with dyspareunia and infertility after the procedure, also there is a potential risk for urinary tract infection after cannulation of the urinary bladder (required in transvaginal NOTES procedures). There is a risk for injury to nearby organs, the rectum and the sigmoid colon are at higher risk than other structures, that is why visualizing the pelvis directly by a laparoscope (through the trocar site) may be a safe method to ensure there are no injuries for pelvic organs. Transvaginal approach may have higher incidence rates for certain complications (bladder injury and vaginal hematoma) than other surgical approaches [9].
Transvaginal cholecystectomy are usually performed with a single 5mm umbilical port. An additional 3mm transabdominal port can be used as a safety precaution in few cases [6]. The average operating time to perform the procedure is 2 hours. Blood loss is less than 50 ml in most cases [6]. Using the laparoscopic hook which is inserted via the umbilical port to dissect the gallbladder from the liver is considered easier, quicker and safer than the dissection by using the smaller size endoscopic hook [6]. Currently, laparoscopic clipping of the cystic duct is the safest and most secured method for securing the duct [6]. More occlusive endoscopic clips and instrumentation should be developed.
In transvaginal NOTES (and most NOTES procedures), insufflation through a laparoscopic port (which can be used also for single laparoscopic instrument insertion) is better controlled than endoscopic insufflation [10].
Transanal/Transrectal NOTES
Transanal rectosegmoid resection using transanal endoscopic microsurgery (TEM) and laparoscopic assistance has been demonstrated to be feasible and safe in a swine survival model and in human cadavers [11]. Currently, there are clinical trials that aim to assess the oncological safety of this approach in treating benign and malignant colorectal tumors.
Transanal colorectal resection procedures requires a stable platform for endolumenal and direct translumenal access to the peritoneal cavity. The first clinical case of a NOTES transanal resection for rectal cancer using TEM and laparoscopic assistance has been performed successfully by a team of surgeons from Barcelona and Boston in 2009 [12]. The progression and substantial improvement in NOTES instrumentation may optimize this approach to be widespread applied in humans, and may ultimately permit completely NOTES transanal colorectal resection instead of abdominoperineal resection (APR), low anterior resection (LAR) and laparoscopic colorectal resection procedures.
Transgastric NOTES
Initially, there were difficulties in achieving orientation and navigation based on retroflection of the endoscopes to visualize the upper abdomen and perform upper abdominal procedures. Better results had been achieved for lower abdominal surgeries, such as pelvic surgery, tubal ligation, and appendectomy.
This NOTES approach is more sophisticated than the transvaginal one, especially in terms of gastric wall closure after extracting the organ (requires laparoscopic assistance [13]. Also, the complications rate is higher in this rout compared with transvaginal route. Trials in the field (on animal and cadaver models) are trying to create a new devices and techniques to simplify the stomach incision closure.
Appendectomy, cholecystectomy and cancer staging have been performed via this approach [14]. Retrieval of dislodged endoscopic gastrostomy tube via this approach has been reported as well [4]. however, all cases require Some degree of hybridization is required for all transgastric NOTES procedures. This approach can be used in all patients (males and females) but the extracted specimen (through the oral cavity) needs to be relatively smaller than those extracted by other routs.
In general, the following steps should be considered for most NOTES transgastric procedures:
- The patient should be in an overnight fasting state. General anesthesia is inducted and single dose intravenous antibiotics are administered (amoxicillin and metronidazole). The position of the patient is usually Lloyd-Davies position.
- Gastric lavage should be done before the procedure using chlorhexidine solution.
- The puncture site is chosen for adequate visibility to perform the procedure. The best areas of entry are the proximal body and the distal antrum (both are relatively avascular) [15].
- A flexible endoscope is inserted via the oral cavity to the stomach, the puncture is made by a needle knife. The puncture site is dilated by an endoscopic balloon and and the scope is inserted into the peritoneal cavity.
- Intraperitoneal pressure is controlled using laparoscopic carbon dioxide insufflator and the procedure is performed. Usually 2 to 3mm trocars are used in the procedure.
- The puncture site is closed by a suturing device after extracting the specimen or the organ via the oral cavity.
Peritonitis and esophageal rupture may occur after transgastric procedures. In general, complications are more common in transgastric procedures than in transvaginal procedures.
Transesophageal NOTES
This approach can be used for the management of achalasia (failure of relaxation of the lower esophageal sphincter that cause dysphagia). Many cases of per oral endoscopic myotomy (POEM) have been performed successfully to treat achalasia [16]. Esophageal injuries could be prevented during performing the procedure by using gastroesophageal overtubes. The instruments and ports for transesophageal NOTES have more restrictions in their size and shape compared with other approaches. Large organ (specimen) extraction is not suitable for this approach (a maximal diameter of 2 cm) according to the relatively smaller size of esophageal lumen compared with other hollow organs.
Transurethral/Transcystic NOTES
Future Directions
Operating on intensive care unit patients may be the future progression in NOTES procedures and may offer many benefits. Transgastric placement of diaphragm pacing for weaning the ICU patients from the ventilator may lead to several potential benefits over other methods of pacing [17]. This procedure could be performed at the bedside.
NOTES may become the preferred method to operate on selected patients (specific population). Morbidly obese patients and those with severe intra abdominal adhesions are good candidates for NOTES.
More studies should be conducted to find clear clarifications for the following issues [18]:
- The best and the safest way to traverse the wall of the lumen in order to get access to the organ.
- Controlling the complications of every single NOTES procedure.
- Improving spatial orientation to perform the procedure.
- The best closure for the translumenal incisional site. Methods of reliable full thickness, watertight closure for the puncture sites in different organs should be developed.
- Specific ways for organ extraction through the natural orifices.
- Methods to prevent infections during NOTES procedures.
- Anesthesia level requirement for every NOTES procedure.
- Optimal instrumentation and devices for every NOTES procedure.
Current Technological Developments
The development of NOTES instruments is emerging to make these procedures feasible and safe. These instruments include platforms and many other tools, such as suturing devices and anastomotic (nonsuturing) devices [19]. The new platform permits the performance of a large intraabdominal procedure in a faster and more accurate fashion.
University of California San Diego and Novare Endosurgical developed a new grasper that can be used in NOTES procedures through the same port of the endoscopes [6]. The grasper is long (around 75 cm) and can be articulated for flexible retraction even. In the same time, it is rigid enough to provide a stronger retraction than the endoscopic grasper [6].
The preferred way to gain access to the peritoneal cavity via a hollow viscus (lumen) is a very small incision (minimal) followed by a balloon expansion and dilatation. A tiny incision can be made using a sphincterotome or a needle knife.
Although a direct insertion of an endoscope and the NOTES instruments is possible, Overtube is usually used to permit multiple entries to the field the procedure and to perform complex maneuvers.
Current, there are many research studies by engineers which focuse on computer assisted imaging systems that provide additional 3-D information of the intervention site. Virtual off-axis view assists surgeons with a better visual depth perception during the intervention [20]. Video images can be rectified using the impact of gravity on a 3-axis accelerometer integrated in the tip of the endoscope [21].
Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR)
Senior leadership from the American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal Endoscopic Suregons (SAGES) organized a working group of surgeons and gastroenterologists who met in New York City on July 22 and 23, 2005 to develop standards for the practice of this emerging technique. This group is known as the Natural Orifice Surgery Consortion for Assessment and Research (NOSCAR). A White Paper on NOTES was released by NOSCAR simultaneously in two medical journals in May 2006 [22]. This paper identified the major areas of research needed to be addressed before NOTES can become a viable clinical application for patients. These areas included development of a reliable closure technique for the internal incision, prevention of infection, and creation of advanced endoscopic surgical tools [23].
NOSCAR tasks include the following:
- Producing White Papers which focus on the challenges that need thought and research.
- Tracking the groups of similar research projects that address the previous challenges.
- Organizing the research projects, enhance collaboration and attract funding to key areas of study.
- Building a robust outcomes database by collecting submission of data.
- Fostering collaborative clinical trials.
The White Paper on NOTES and the guidlines for participation in NOSCAR can be found in the external links below [24].
Conclusions
Natural orifice transluminal surgery (NOTES) is a rapidly evolving field which may shift the minimally invasive surgery world from laparoscopic and video assisted thoracic surgery to procedures that can be done via the natural body orifices without any abdominal or thoracic incisions. NOTES may be a feasible, safe, and reasonable option for abdominal surgery. It may provide many advantages and lessen many surgical complications. New NOTES procedures should be experimental at the beginning, and they should be performed only in research labs in advanced institutions before applying NOTES clinically.
We are on the way for routine clinical applications of NOTES by the steady progression of the field. Patient safety and the research trials that ensure this safety is paramount. Innovative instruments are needed for the surgeons and gastroenterologists to perform safe NOTES procedures. The development of such therapeutic techniques and advanced endoscopic devices will allow the endoscopists to perform various procedures more easily, such as resection of large and deep mucosal lesions and taking full thickness biopsies [25].
International NOTES research groups, such as NOSCAR, EURO-NOTES, ASIA-NOTES, NOSLA (Natural Orifice Surgery Latin America), EATS (European Association of Translumenal Surgery) and others currently work to improve NOTES field and aim to provide registries for NOTES procedures worldwide.
Finally, enthusiasm and conducting laboratory studies and clinical trials are required for further improvements in the field in order to provide the best possible patient care for our patients.
Published Trials
- A transgastric debridement of necrotizing pancreatitis was performed using flexible endoscope in 2000 by Seifert et al [26]. This was initial description for the transgastric access to perform procedures.
- In 2002, Gettman et al published a transvaginal nephrectomy in a porcine model [27].
- A novel endoscopic peroral transgastric approach to the peritoneal cavity was tested in a porcine model in acute and long-term survival experiments at Johns Hopkins Medical Center in 2004 by Kalloo et al [28]. He demonstrated the feasibility and safety of this approach to be an alternative to laparoscopy and laparotomy. The peritoneal cavity was examined, and a liver biopsy specimen was obtained. The gastric wall incision was closed with clips [28].
- A transgastric lymphadenectomy has been performed in a survival porcine model by Fritscher-Ravens et al and reported in 2004 [29]. This study showed that EUS (Endoscopic Ultrasonography) guided transgastric approach for lymph node selection and lymphadenectomy is feasible.
- A transgastric fallopian tube ligation has been reported in a porcine survival model in 2005 by Jagannath et al [30].
- A transgastric partial hysterectomy and oophorectomy in a porcine survival model has been reported in 2005 by Wagh et al [31].
- A transgastric cholecystectomy and cholecystogastric anastomosis in a nonsurvival model has been reported in 2005 by Park et al [32].
- A transgastric gastrojejunostomy procedure in a porcine survival model has been reported in 2005 by Kantsevoy et al [33].
- A transvesical liver biopsy has been performed on pigs (survival and nonsurvival models) and reported in 2006 by Lima et al [34]. This study provided encouragement for additional preclinical studies of transvesical surgery to design new intra-abdominal scarless procedures in what seems to be third generation surgery.
- A transgastric splenectomy has been performed in a nonsurvival porcine model and reported in 2006 by Kantsevoy et al [35].
- A new transgastric closure method for stomach incisions has been compared to other closure methods in 2007 by Ryou et al [36]. The study showed by using ex vivo porcine stomach model that prototype gastrotomy device yields the highest median air leak pressure (most leak-resistant gastrotomy closure) compared to the QuickClip closure method and the hand-sewn closure. This method also dramatically diminishes the time for incision and gastrotomy closure to approximately 5 min [36].
- A transcolonic abdominal exploration in a swine survival model has been performed by Fong et al and reported in 2007 [37]. In contrast to the transgastric method, a transcolonic approach provides more consistent identification of structures in the upper abdomen and provides better en face orientation and scope stability.
- A transgastric diaphragmatic pacing and peritoneal exploration procedure in a nonsurvival porcine model has been performed by Onders et al and reported in 2007 [17]. This study demonstrated the feasibility of transgastric mapping of the diaphragm and implantation of a percutaneous electrode for therapeutic diaphragmatic stimulation.
- A transgastric intraperitoneal pressure measurement procedure has been performed in a nonsurvival porcine model and reported in 2007 by Meirless et al [10]. This study demonstrated that the use of an on-demand unregulated endoscopic insufflator for translumenal surgery can cause large variation in intraperitoneal pressures, which may lead to hemodynamic compromise. Well-controlled intraabdominal pressures that is achieved with a standard autoregulated laparoscopic insufflator maybe much safer.
- Radical sigmoidectomy using a pure NOTES transanal approach was first described in 3 human cadavers in 2007 by Whiteford et al [38]. They used TEM as an endoscopic platform to perform the procedure without the need of any abdominal incisions [38]. This showed that NOTES sigmoid colon resection with en bloc lymphadenectomy and primary anastomosis can be performed successfully, and it is possible to complete the critical steps of NOTES sigmoid resection, en bloc lymphadenectomy, primary anastomosis, and retrieval of an intact specimen without any incisions by using transanal endoscopic microsurgery instrumentation.
- Completely NOTES transvaginal cholecystectomy has been reported by a team of surgeons in Philadelphia (USA). The patient was discharged on the day of surgery and has not suffered any complication after 1 month of follow-up. Pure NOTES transvaginal cholecystectomy without aid of laparoscopic or needleoscopic instruments is feasible and safe in humans [39].
- The first series of transvaginal NOTES cholecystectomy has been performed by the NOTES Research Group in Rio de Janeiro (Brazil) in 2007, based in previous experimental studies. The first human transvaginal endoscopic cholecystectomy case was reported in 2007 [40].
- A transvaginal laparoscopically assisted endoscopic cholecystectomy has been reported by Marc Bessler [41].
- Transgastric appendectomy has been performed by Santiago Horgan in 2008 [6]. The patient's appendix was removed through the mouth. Dr. Horgan also applied the EndoSurgical Operating System (EOS) on pigs to perform the entire operation through the stomach without laparoscopic assistance or any abdominal incision.
- 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 case of robotic-assisted laparoscopic live-donor transvaginal nephrectomy with the uterus in place has been performed by a multidisciplinary team of surgeons at University of Pavia (Italy) in 2010 [42]. The initial experience with the combination of robotic surgery and transvaginal extraction of the donated organ has opened a new opportunity to minimize trauma in transplant surgery.
- A NOTES transanal resection for rectal cancer using TEM and laparoscopic assistance has been performed in a 76-year-old woman at the Hospital Clinic in Barcelona by a team of surgeons from the Hospital Clinic in Barcelona and Massachusetts General Hospital/Boston in November 2009 [12].
- Transvaginal purely endoscopic appendectomies were reported in 2008 by investigators from Germany and by another group of investigators from India [43][44].
Videos
External Links
- http://www.noscar.org/wp-content/uploads/2011/01/NOTES_White_Paper_Feb06.pdf
- http://www.noscar.org/
- http://www.noscar.org/outcomes.php
- http://www.dgav.de/english/notes.html
- http://www.euronotes.world.it/
- http://www.japan-medical-tourism.com/content/natural-orifice-translumenal-endoscopic-surgery-notes-japan
References
- ↑ Rao GV, Reddy DN. Transgastric appendectomy in humans. Montreal: World Congress of Gastroenterology, 2006
- ↑ 2.0 2.1 Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Büsing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010). "The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients". Ann. Surg. 252 (2): 263–70. doi:10.1097/SLA.0b013e3181e6240f. PMID 20585238. Retrieved 2012-02-27. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 Chukwumah C, Zorron R, Marks JM, Ponsky JL (2010). "Current status of natural orifice translumenal endoscopic surgery (NOTES)". Curr Probl Surg. 47 (8): 630–68. doi:10.1067/j.cpsurg.2010.04.002. PMID 20620259. Retrieved 2012-02-27. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 Marks JM, Ponsky JL, Pearl JP, McGee MF (2007). "PEG "Rescue": a practical NOTES technique". Surg Endosc. 21 (5): 816–9. doi:10.1007/s00464-007-9361-2. PMID 17404790. Retrieved 2012-03-01. Unknown parameter
|month=ignored (help) - ↑ Schulman JD, Dorfmann AD, Jones SL, Pitt CC, Joyce B, Patton LA (1987). "Outpatient in vitro fertilization using transvaginal ultrasound-guided oocyte retrieval". Obstet Gynecol. 69 (4): 665–8. PMID 3103035. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Horgan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P (2009). "Natural orifice surgery: initial clinical experience". Surg Endosc. 23 (7): 1512–8. doi:10.1007/s00464-009-0428-0. PMC 2695868. PMID 19343435. Retrieved 2012-03-05. Unknown parameter
|month=ignored (help) - ↑ McCracken G, Lefebvre GG (2007). "Vaginal hysterectomy: dispelling the myths". J Obstet Gynaecol Can. 29 (5): 424–8. PMID 17493374. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Roussis NP, Waltrous L, Kerr A, Robertazzi R, Cabbad MF (2004). "Sexual response in the patient after hysterectomy: total abdominal versus supracervical versus vaginal procedure". Am. J. Obstet. Gynecol. 190 (5): 1427–8. doi:10.1016/j.ajog.2004.01.074. PMID 15167858. Retrieved 2012-03-06. Unknown parameter
|month=ignored (help) - ↑ Milad MP, Morrison K, Sokol A, Miller D, Kirkpatrick L (2001). "A comparison of laparoscopic supracervical hysterectomy vs laparoscopically assisted vaginal hysterectomy". Surg Endosc. 15 (3): 286–8. doi:10.1007/s004640000328. PMID 11344430. Retrieved 2012-03-06. Unknown parameter
|month=ignored (help) - ↑ 10.0 10.1 Meireles O, Kantsevoy SV, Kalloo AN, Jagannath SB, Giday SA, Magno P, Shih SP, Hanly EJ, Ko CW, Beitler DM, Marohn MR (2007). "Comparison of intraabdominal pressures using the gastroscope and laparoscope for transgastric surgery". Surg Endosc. 21 (6): 998–1001. doi:10.1007/s00464-006-9167-7. PMID 17404796. Retrieved 2012-03-05. Unknown parameter
|month=ignored (help) - ↑ Sylla P, Sohn DK, Cizginer S, Konuk Y, Turner BG, Gee DW, Willingham FF, Hsu M, Mino-Kenudson M, Brugge WR, Rattner DW (2010). "Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model". Surg Endosc. 24 (8): 2022–30. doi:10.1007/s00464-010-0898-0. PMID 20174948. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ 12.0 12.1 Sylla P, Rattner DW, Delgado S, Lacy AM (2010). "NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance". Surg Endosc. 24 (5): 1205–10. doi:10.1007/s00464-010-0965-6. PMID 20186432. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Nikfarjam M, McGee MF, Trunzo JA, Onders RP, Pearl JP, Poulose BK, Chak A, Ponsky JL, Marks JM (2010). "Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and gastrotomy site selection by using a hybrid technique". Gastrointest. Endosc. 72 (2): 279–83. doi:10.1016/j.gie.2010.03.1070. PMID 20541750. Retrieved 2012-02-27. Unknown parameter
|month=ignored (help) - ↑ Zorrón R, Soldan M, Filgueiras M, Maggioni LC, Pombo L, Oliveira AL (2008). "NOTES: transvaginal for cancer diagnostic staging: preliminary clinical application". Surg Innov. 15 (3): 161–5. doi:10.1177/1553350608320553. PMID 18614547. Retrieved 2012-02-27. Unknown parameter
|month=ignored (help) - ↑ Rao GV, Reddy DN, Banerjee R (2008). "NOTES: human experience". Gastrointest. Endosc. Clin. N. Am. 18 (2): 361–70, x. doi:10.1016/j.giec.2008.01.007. PMID 18381176. Retrieved 2012-03-05. Unknown parameter
|month=ignored (help) - ↑ Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Gostout CJ (2007). "Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia". Endoscopy. 39 (9): 761–4. doi:10.1055/s-2007-966764. PMID 17703382. Retrieved 2012-02-27. Unknown parameter
|month=ignored (help) - ↑ 17.0 17.1 Onders R, McGee MF, Marks J, Chak A, Schilz R, Rosen MJ, Ignagni A, Faulx A, Elmo MJ, Schomisch S, Ponsky J (2007). "Diaphragm pacing with natural orifice transluminal endoscopic surgery: potential for difficult-to-wean intensive care unit patients". Surg Endosc. 21 (3): 475–9. doi:10.1007/s00464-006-9125-4. PMID 17177078. Retrieved 2012-02-22. Unknown parameter
|month=ignored (help) - ↑ Flora ED, Wilson TG, Martin IJ, O'Rourke NA, Maddern GJ (2008). "A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery: experimental models, techniques, and applicability to the clinical setting". Ann. Surg. 247 (4): 583–602. doi:10.1097/SLA.0b013e3181656ce9. PMID 18362621. Retrieved 2012-02-29. Unknown parameter
|month=ignored (help) - ↑ Mummadi RR, Pasricha PJ (2008). "The eagle or the snake: platforms for NOTES and radical endoscopic therapy". Gastrointest. Endosc. Clin. N. Am. 18 (2): 279–89, viii. doi:10.1016/j.giec.2008.01.005. PMID 18381169. Retrieved 2012-02-23. Unknown parameter
|month=ignored (help) - ↑ ^ Hoeller, Kurt (2010). Novel Techniques for Spatial Orientation in Natural Orifice Translumenal Endoscopic Surgery (NOTES) (Ph.D.). Central Institute of Healthcare Engineering (ZiMT) at Friedrich-Alexander-Universitaet Erlangen-Nuernberg (FAU). ISBN 978-3-8322-9766-4
- ↑ ^ WO application 2010105946, Gutiérrez Boronat, Javier; Jahn, Jasper; Schneider, Armin; Hoeller, Kurt, "Endoscope and Imaging Device", published 2010-09-23, assigned to Fraunhofer-Gesellschaft zur Foerderung der angewandten Forschung e.V.
- ↑ "ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery White Paper October 2005". Gastrointest. Endosc. 63 (2): 199–203. 2006. doi:10.1016/j.gie.2005.12.007. PMID 16427920. Retrieved 2012-02-22. Unknown parameter
|month=ignored (help) - ↑ Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR)
- ↑ D. Rattner, A. Kalloo, and the SAGES/ASGE Working Group on Natural Orifice Translumenal Endoscopic Surgery
- ↑ Jay Pasricha P, Krummel TM (2009). "NOTES and other emerging trends in gastrointestinal endoscopy and surgery: the change that we need and the change that is real". Am. J. Gastroenterol. 104 (10): 2384–6. doi:10.1038/ajg.2009.150. PMID 19806084. Retrieved 2012-02-27. Unknown parameter
|month=ignored (help) - ↑ Seifert H, Wehrmann T, Schmitt T, Zeuzem S, Caspary WF (2000). "Retroperitoneal endoscopic debridement for infected peripancreatic necrosis". Lancet. 356 (9230): 653–5. doi:10.1016/S0140-6736(00)02611-8. PMID 10968442. Retrieved 2012-03-05. Unknown parameter
|month=ignored (help) - ↑ Gettman MT, Lotan Y, Napper CA, Cadeddu JA. Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 2002; 59: 446-450
- ↑ 28.0 28.1 Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004). "Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity". Gastrointest. Endosc. 60 (1): 114–7. PMID 15229442. Retrieved 2012-02-16. Unknown parameter
|month=ignored (help) - ↑ Fritscher-Ravens A, Mosse CA, Ikeda K, Swain P (2006). "Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance". Gastrointest. Endosc. 63 (2): 302–6. doi:10.1016/j.gie.2005.10.026. PMID 16427939. Retrieved 2012-03-01. Unknown parameter
|month=ignored (help) - ↑ Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005). "Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model". Gastrointest. Endosc. 61 (3): 449–53. PMID 15758923. Retrieved 2012-02-29. Unknown parameter
|month=ignored (help) - ↑ Wagh MS, Merrifield BF, Thompson CC (2005). "Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model". Clin. Gastroenterol. Hepatol. 3 (9): 892–6. PMID 16234027. Retrieved 2012-02-29. Unknown parameter
|month=ignored (help) - ↑ Park PO, Bergström M, Ikeda K, Fritscher-Ravens A, Swain P (2005). "Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos)". Gastrointest. Endosc. 61 (4): 601–6. PMID 15812420. Retrieved 2012-02-29. Unknown parameter
|month=ignored (help) - ↑ Kantsevoy SV, Jagannath SB, Niiyama H, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Shimonaka H, Kalloo AN (2005). "Endoscopic gastrojejunostomy with survival in a porcine model". Gastrointest. Endosc. 62 (2): 287–92. PMID 16046997. Retrieved 2012-03-01. Unknown parameter
|month=ignored (help) - ↑ Lima E, Rolanda C, Pêgo JM, Henriques-Coelho T, Silva D, Carvalho JL, Correia-Pinto J (2006). "Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery". J. Urol. 176 (2): 802–5. doi:10.1016/j.juro.2006.03.075. Retrieved 2012-03-01. Unknown parameter
|month=ignored (help) - ↑ Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Pipitone LJ, Talamini MA, Kalloo AN (2006). "Transgastric endoscopic splenectomy: is it possible?". Surg Endosc. 20 (3): 522–5. doi:10.1007/s00464-005-0263-x. PMID 16432652. Retrieved 2012-03-01. Unknown parameter
|month=ignored (help) - ↑ 36.0 36.1 Ryou M, Pai RD, Pai R, Sauer JS, Sauer J, Rattner DW, Rattner D, Thompson CC, Thompson C (2007). "Evaluating an optimal gastric closure method for transgastric surgery". Surg Endosc. 21 (4): 677–80. doi:10.1007/s00464-006-9075-x. PMID 17160493. Retrieved 2012-03-01. Unknown parameter
|month=ignored (help) - ↑ Fong DG, Pai RD, Thompson CC (2007). "Transcolonic endoscopic abdominal exploration: a NOTES survival study in a porcine model". Gastrointest. Endosc. 65 (2): 312–8. doi:10.1016/j.gie.2006.08.005. PMID 17173916. Retrieved 2012-03-01. Unknown parameter
|month=ignored (help) - ↑ 38.0 38.1 Whiteford MH, Denk PM, Swanström LL (2007). "Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery". Surg Endosc. 21 (10): 1870–4. doi:10.1007/s00464-007-9552-x. PMID 17705068. Retrieved 2012-02-15. Unknown parameter
|month=ignored (help) - ↑ Gumbs AA, Fowler D, Milone L, Evanko JC, Ude AO, Stevens P, Bessler M (2009). "Transvaginal natural orifice translumenal endoscopic surgery cholecystectomy: early evolution of the technique". Ann. Surg. 249 (6): 908–12. doi:10.1097/SLA.0b013e3181a802e2. PMID 19474690. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007). "Surgery without scars: report of transluminal cholecystectomy in a human being". Arch Surg. 142 (9): 823–6, discussion 826–7. doi:10.1001/archsurg.142.9.823. PMID 17875836. Retrieved 2012-02-15. Unknown parameter
|month=ignored (help) - ↑ Bessler M, Stevens PD, Milone L, Parikh M, Fowler D (2007). "Transvaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery". Gastrointest. Endosc. 66 (6): 1243–5. doi:10.1016/j.gie.2007.08.017. PMID 17892873. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Pietrabissa A, Abelli M, Spinillo A, Alessiani M, Zonta S, Ticozzelli E, Peri A, Dal Canton A, Dionigi P (2010). "Robotic-assisted laparoscopic donor nephrectomy with transvaginal extraction of the kidney". Am. J. Transplant. 10 (12): 2708–11. doi:10.1111/j.1600-6143.2010.03305.x. PMID 21114647. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Bernhardt J, Gerber B, Schober HC, Kähler G, Ludwig K (2008). "NOTES--case report of a unidirectional flexible appendectomy". Int J Colorectal Dis. 23 (5): 547–50. doi:10.1007/s00384-007-0427-3. PMID 18256848. Retrieved 2012-02-29. Unknown parameter
|month=ignored (help) - ↑ Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Prasad M (2008). "Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES--world's first report". Surg Endosc. 22 (5): 1343–7. doi:10.1007/s00464-008-9811-5. PMID 18347865. Retrieved 2012-02-29. Unknown parameter
|month=ignored (help)