A Review of Natural Orifice Translumenal Endoscopic Surgery (NOTES) for Intra-abdominal Surgery

Abstract

NOTES is still in early stages of development and more robust technologies will be needed to achieve reliable closure and overcome technical challenges. Well-managed human studies need to be conducted to determine the safety and efficacy of NOTES in a clinical setting.

Transvesical NOTES: Survival Study in Porcine Model

“…According to the study published by Della Flora et al. 2 only 3 trials were registered with the Clinical Trials Register in 2008, at which time none was complete and only 1 article had been published. Now, we have reports of human transvaginal cholecystectomies being performed without complications by Bessler et al 7 in New York City (Hybrid), by Zorron et al 8 in Rio De Janeiro, Brazil, and by a group led by Marescaux 9 in Strasbourg, France.…”

“…2 A working group established at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) leadership meeting in Chicago (2005) developed guidelines for the implementation of NOTES, which were outlined in the resulting “NOTES White Paper.” 11 It was apparent that although performing NOTES procedures is technically possible, substantial refinement is needed in this field in terms of technology, for comparison with established procedures in a clinical setting. The aim of our study was to contribute towards this refinement, by demonstrating the efficacy of the transvesical route as a safe portal of entry into the abdominal cavity, and performing procedures thereon.…”

“…However, it also shares the potential for many complications associated with laparoscopic surgery: difficulties with poor visibility, maneuverability, and organ grasping are likely to be increased as distances are further and the equipment needed is likely to be more specialized. 2 Other problems are associated with NOTES, the biggest being the risk of contamination in performing a relatively sterile procedure through a contaminated portal (i.e., the gastrointestinal or the genitourinary tract), and the problem of successful subsequent closure of the viscerotomy wound.…”

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

“…Within the last years, significant research efforts have focussed on developing safe and reproducible transluminal endoscopic approaches to perform various intra-abdominal procedures [146]. Recently a first clinical case of NOTES transanal resection for rectal cancer using TEM and laparoscopic assistance has been reported [147].…”

Current Evidence in Gastrointestinal Surgery: Natural Orifice Translumenal Endoscopic Surgery (NOTES)

“…29 To date, viscerotomy closure has not been achieved reliably in humans, and the subsequent risk of peritoneal infection remains a valid concern. 30 The tissue apposition system (TAS) may be a promising device for endoscopic suturing. In human subjects, TAS was feasible as an alternative to laparoscopic colectomy for endoscopically unresectable polyps.…”