Natural orifice translumenal endoscopic surgery (NOTES)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Mohammed A. Sbeih, M.D. [2]

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.
• NOTES was originally described in animals by researchers at Johns Hopkins University (Dr. Anthony Kalloo et al.), and was used for transgastric appendectomy in humans in India (by Drs. G.V. Rao and N. Reddy).
• On June 25, 2007 Swanstrom and colleagues reported the first human transgastric cholecystectomy .
• Totally transvaginal cholecystectomy has been described in experimental model without using laparoscopic assistance .
• 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.
• 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 .

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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