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.
  • In 1940s, the first natural orifice procedure has been mentioned. Culdoscopies were performed using an endoscope passed through the recto-uterine pouch to view pelvic organs [1].
  • 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 [2].
  • In 2002, Gettman et al published a transvaginal nephrectomy in a porcine model [3].
  • The first reported human transgastric endoscopic appendectomy was in India in 2003 by Dr. G.V. Rao and Dr. N. Reddy [4].
  • NOTES was originally described in animals by researchers at Johns Hopkins University. Dr. Anthony Kalloo published the first report of a true transluminal procedure in 2004 , which was a transgastric peritoneoscopy in a porcine model [5].
  • 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 [7].
  • The first published human NOTES procedure was by Marks et al[8] who performed a transgastric rescue of a prematurely dislodge gastrostomy tube in 2007.
  • The first natural orifice transluminal cholecystectomy in humans was performed in Strasbourg, France [9].
  • 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 [10][11].
  • 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 [12].
  • 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 [13].

NOTES Advantages Over Current Surgical Techniques and The Single Incision Laparoscopic Surgery (SILS)

Experimental Evolution

What has been achieved so far?

  • Laboratory Reports
  • Human Cases

Current Challenges to Clinical Application of NOTES and the Drawbacks

Human Experience

Potential Applications

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

Future Directions

Current Technologic Developments

Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR)

Conclusions

Published Studies

Videos

External links

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References

  1. ↑ Halim I, Tavakkolizadeh A. NOTES: The next surgical revolution? Int J Surg 2008; 6: 273-276
  2. ↑ SJ, Warnock GL. A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J Laparoendosc Adv Surg Tech A 1997; 7: 369-373
  3. ↑ Gettman MT, Lotan Y, Napper CA, Cadeddu JA. Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 2002; 59: 446-450
  4. ↑ Rao GV, Reddy DN. Transgastric appendectomy in humans. Montreal: World Congress of Gastroenterology, 2006
  5. ↑ Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004; 60: 114-117
  6. ↑ Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR)
  7. ↑ 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)
  8. ↑ Marks JM, Ponsky JL, Pearl JP, McGee MF. PEG "Rescue": a practical NOTES technique. Surg Endosc 2007; 21: 816-819
  9. ↑ Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 2007; 142: 823-826; discussion 823-826
  10. ↑ 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)
  11. ↑ 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 2012-02-15. Unknown parameter |month= ignored (help)
  12. ↑ "Surgeons Remove Healthy Kidney Through Vagina". InfoNIAC.com. Retrieved 2009-02-03.
  13. ↑ 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 2012-02-15. Unknown parameter |month= ignored (help)

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