Natural orifice translumenal surgery: from scales to symphonies

Abstract

Despite the widespread interest in this technology, there are a lot of shortcomings: limitations in equipment, lack of clinical outcome data, and absence of randomized trials that compare it with alternative conventional surgical interventions. Nevertheless, it is crucial to remember that we have just started the evaluation process for this new exiting technology, and that, clearly, the best is yet to come.

Patient preferences for surgical techniques: should we invest in new approaches?

“…The majority of the work done on NOTES has been based on animal models but some human cases have been reported [2][3][4], although some safety issues have been raised [6,7]. A number of challenges faced by NOTES were highlighted in a recent white paper [8].…”

Transgastric and Transperineal Natural Orifice Translumenal Endoscopic Surgery (NOTES) in an Appendectomy Test Bed

“…These challenges invariably stem from the marriage of surgery and flexible endoscopy. 13 This NOTES appendectomy test bed has demonstrated promise in the evaluation of NOTES techniques.…”

Natural orifice translumenal endoscopic surgery 2009: what is the future for the gastroenterologist?

“…It is not as yet clear what would be the ideal platform for NOTES [51] and which type of spatial orientation (fixed image horizon versus off-axis orientation) is better [5]. A provocative idea of 'deconstruction of the endoscope' has been suggested by some [52].…”

“…The formation of the Natural Orifice Surgery Consortium for Assessment and Research in 2006, which is a collaboration of American Society for Gastrointestinal Endoscopy and Society of American Gastrointestinal and Endoscopic Surgeons [2, 3], was a seminal event. Their objective is to perform therapeutic interventions (including novel procedures) for improved patient care such as the theoretical advantages of cosmesis, decreased incidence of wound infection, adhesions and incisional hernias, decreased need for sedation and easier access to retroperitoneum [4,5].…”