Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base

Abstract

Introduction. Appropriate prevention of infection is a key area of research in natural orifice translumenal endoscopic surgery (NOTES), as identified by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR). Methods. A review of the literature was conducted evaluating the evidence base for access orifice preparation/treatment in NOTES procedures in the context of infectious complications. Recommendations based on the Oxford Centre for Evidence-Based Medicine guidelines were made. Results. The most robust evidence includes several experimental randomised controlled trials assessing infectious complications in the transgastric approach to NOTES. Transvaginal procedures are long established for accessing the peritoneal cavity following disinfection with antiseptic. Only experimental case series for transcolonic and transvesical approaches are described. Conclusion. Grade C recommendation requiring no preoperative preparation can be made for the transgastric approach. Antiseptic irrigation is recommended for transvaginal (grade C) NOTES access, as is current practice. Further human trials need to be conducted to corroborate the current evidence base for transgastric closure. It is important that future trials are conducted in a methodologically robust fashion, with emphasis on clinical outcomes and standardisation of enterotomy closure and postoperative therapy.

A reliable detachable balloon that prevents abdominal cavity contamination during transrectal natural orifice transluminal endoscopic surgery

“…Although the transrectal approach presents with several advantages over other approaches using NOTES, transrectal NOTES are rarely used in clinical practice. The rectum is easily contaminated by the streaming fecal matter during the procedures even if the colonic lumen is thoroughly disinfected . Preventing contamination is essential for transrectal NOTES in order to bring it into clinical application .…”

“…The rectum is easily contaminated by the streaming fecal matter during the procedures even if the colonic lumen is thoroughly disinfected. [13][14][15][16] Preventing contamination is essential for transrectal NOTES in order to bring it into clinical application. 17 Therefore, many attempts have been made to make this possible.…”

Natural oriffice transluminal endoscoping surgery – transgastric approach

“…Another question is how to avoid the contamination of the abdominal cavity by the microfl ora from places of the endoscope way (oral cavity, stomach, intestine, vagina). We reduced the risk of bacterial contamination by antiseptic washes of the appropriate organ against the penetration into the abdominal cavity to some extent (22). The possible solution is to use the over tube which is put on the endoscope and fi xed with the end in the organ wall after going into the abdominal cavity, in our case, it is the wall of the stomach.…”

New minimally invasive approaches for cholecystectomy: Review of literature

“…Impediments for the adoption of other types of NOTES cholecystectomy include skepticism on transgressing and closing mucosal barriers [51] , but also the lack of technological evolution of surgical tools and platforms that need to catch up with the innovative minds of surgeons.…”