Emerging technologies including robotics and natural orifice transluminal endoscopic surgery (NOTES) colorectal surgery

Abstract

Endoluminal and minimally invasive techniques have a long history and bright future in colorectal surgery. First, we will examine how old (colonoscopy) and new (laparoscopy) techniques combine in the form of laparoscopically assisted colonoscopic polypectomy for removal of "colonoscopically unresectable" colon polyps. Next, we will review the early experiences with robot-assisted minimally invasive colon resections. Lastly, we will introduce the next frontier in minimally invasive surgery, natural orifice transluminal endoscopic surgery (NOTES).

MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human

“…The future application of NOTES for large-organ intra-abdominal surgery (colorectal, gastric, spleen) depends not only on the improvement of endoscopes, but also on the invention and development of a range of new devices for flexible endosurgery instrumentation and a safe and efficient form of tissue approximation for defect closure [24].…”

Tissue apposition system: new technology to minimize surgery for endoscopically unresectable colonic polyps

“…Unlike the perpendicular approach found in the stomach, as might be required for a NOTES procedure [11], the oblique angle of placement in the colon sometimes made it difficult to place the sutures. The currently available TAS is likely to undergo enhancements in future generations of the device, which will further facilitate use and potentially facilitate adoption by a wider population of endoscopists.…”

“…The lack of endoscopic suturing devices, however, limits this approach. Although increasing interest in natural orifice approaches to surgical intervention has increased research efforts into endoscopic closure devices, none has reached routine clinical practice [11].…”

Hybrid vaginal MA-NOS sleeve gastrectomy: technical note on the procedure in a patient

“…The ideal scenario would be a stable platform for both optics and mechanical forces (traction, counter-traction), which would allow passage of effectors or instruments. The future application of NOTES for large organ intra-abdominal surgery (colorectal, gastric, spleen) depends not only on the improvement of endoscopes, but also on the design and development of a range of new devices for flexible endosurgery instrumentation and a safe and efficient form of tissue approximation for defect closure [30].…”