Endoluminal and transluminal surgery: current status and future possibilities

Abstract

The field of minimally invasive surgery has seen tremendous growth since the first laparoscopic cholecystectomy was performed in 1987. The key question is not how successful these techniques are currently, but rather where may they lead in the future? New technologies promise to usher in an era of even less invasive procedures. The terms being coined in the literature include "incisionless," "endoluminal," "transluminal," and "natural orifice" transluminal endoscopic surgery. These techniques certainly have the potential to become the next wave of minimally invasive procedures. A recent editorial in Surgical Endoscopy by Macfadyen and Cuschieri highlighted the ongoing developments in endoscopic surgery and stressed the critical importance of surgeons being involved in future applications and permutations of these techniques [1]. There are early signs of such involvement. The work of numerous investigators in the field was presented recently at the 2005 Digestive Disease Week. The American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), in collaboration with the American College of Surgeons, recently organized a postgraduate course in endoluminal therapy at the spring 2005 meeting held in Hollywood, Florida. The course is being offered again at the 2006 SAGES annual meeting. Similar courses are being offered at other regional and national meetings. This review attempts to highlight some of the available and evolving endoluminal therapies reviewed at that forum, including techniques for the management of gastroesophageal reflux disease, endoscopic mucosal resection, endoluminal bariatric surgery, transanal endoscopic microsurgery, and transgastric endoscopic surgery, as well as new technologies and possible future directions in luminal access surgery.

Transvesical endoscopic peritoneoscopy: Intra-abdominal scarless surgery for urologic applications

“…NOTES is a revolutionary peritoneal cavity intervention; a natural convergence of intraluminal (endoscopy) and extraluminal (laparoscopy) endoscopic techniques [19]; a third-generation surgery after open surgery (first generation) and laparoscopy (second generation) [16,18••,20] that requires new equipment, special training, and often interdisciplinary collaboration. Advantages over other approaches include no scarring, less anesthesia and postoperative pain, no abdominal wound infection or incisional hernia, fewer adhesions and postoperative ileus, and more rapid recovery [17••].…”

Robotic flexible endoscope

“…As seen from open to keyhole surgery, endoluminal surgery further reduces post-operative pain, recovery time and psychological impact. Current applications for endoluminal surgery include endoscopic resection of large colonic, gastric and esophageal mucosal lesions (mucosectomy) as well as endoluminal therapies for gastroesophageal reflux disease (GERD), and bariatric surgery [Dunkin et al, 2009;Malik et al, 2006]. In these procedures physicians have to deal with the limitations of current available flexible endoscopes and instruments.…”

“…The internal membrane of the digestive tract or vagina is perforated to reach the abdominal or thoracic cavity, thereby avoiding external incisions. This surgical approach is also known as Natural Orifice Transluminal Endoscopic Surgery (NOTES) and performed in experimental interventions, like tubal ligation, cholecystectomy, gastrojejunostomy, splenectomy, and myotomy [Malik et al, 2006;Rattner and Kalloo, 2006;Makris et al, 2010].…”

“…Extensive training under the guidance of a skilled endoscopist is required to perform the procedure efficient, effectively, and safe [Matsui et al, 2012;Kim et al, 2012]. It is expected that ESD and other endoluminal surgical procedures are generally adopted by physicians if the enabling technology, that improves the dexterity of the physician, is available [Malik et al, 2006;Yeung and Gourlay, 2012].…”

“…The potential of natural orifice surgery is obvious [Malik et al, 2006;Yeung and Gourlay, 2012]. New endoluminal procedures can replace more invasive procedures.…”