Natural Orifice Translumenal Endoscopic Surgery in Humans: A Review

Abstract

Natural orifice translumenal endoscopic surgery (NOTES) had its origins in numerous small animal studies primarily examining safety and feasibility. In human trials, safety and feasibility remain at the forefront; however, additional logistic, practical, and regulatory requirements must be addressed. The purpose of this paper is to evaluate and summarize published studies to date of NOTES in humans. The literature review was performed using PUBMED and MEDLINE databases. Articles published in human populations between 2007 and 2011 were evaluated. A review of this time period resulted in 48 studies describing procedures in 916 patients. Transcolonic and transvesicular procedures were excluded. The most common procedure was cholecystectomy (682, 75%). The most common approach was transvaginal (721, 79%). 424 procedures (46%) were pure NOTES and 491 (54%) were hybrid NOTES cases. 127 (14%) were performed in the United States of America and 789 (86%) were performed internationally. Since 2007, there has been major development in NOTES in human populations. A preponderance of published NOTES procedures were performed internationally. With further development, NOTES may make less invasive surgery available to a larger human population.

Natural orifice transluminal endoscopic surgery

“…4 In a recent review of NOTES procedures in humans, 54% were hybrid techniques, highlighting the penetration and importance of the approach. 15 Heller myotomy is a popular treatment for achalasia owing to its effectiveness and the ability to use a laparoscopic approach. 29,30 However, it may result in significant gastroesophageal reflux requiring additional antireflux surgery.…”

Design and Analysis of a Novel Articulated Drive Mechanism for Multifunctional NOTES Robot

“…For the first curvature section, if the pitch angle rotates h 1 , and yaw angle rotates h 2 , the displacements (d [1][2][3][4] ) are as follows: …”

“…Compared with open surgery and traditional MIS, the lack of external skin incisions during NOTES provides patients with more potential advantages such as no visible scarring, less postoperative pain and a lower anesthesia requirement [3]. In addition, several natural orifices with different advantages for different kinds of NOTES procedures provide surgeons with multiple choices according to the specific surgical requirements [4]. The first test of NOTES was performed on a porcine model by Kalloo et al [5], and human NOTES shortly followed [6].…”

A Case of Splenic Metastasis of Ovarian Cancer Treated with Complete Laparoscopic Splenectomy and Transvaginal Specimen Extraction

“…To explore an even less invasive form of laparoscopic surgery, "natural orifice transluminal endoscopic surgery" (NOTES), in which the surgical maneuvers and organ extraction are performed through natural orifices without creating abdominal wounds, has been attempted [2,3]. NOTES has the major advantage of circumventing the requirement for developing a small abdominal incision; however, NOTES still has technical issues and difficulties with regard to its clinical application [4]. "Natural orifice specimen extraction" (NOSE) techniques that are similar to NOTES have been attempted in recent years.…”