Transvaginal Natural Orifice Transluminal Endoscopic Surgery (Notes): Surgical Technique and Results

Kondo, William; Branco, Aníbal Wood; Filho, Alcides José Branco; Noda, Rafael William; Zomer, Monica Tessmann; Charles, Lorne; Bourdel, Nicolas; Zorrón, Ricardo

doi:10.5772/16777

Cited by 4 publications

(5 citation statements)

References 85 publications

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“…These issues contributed to increase the operative time in the hybrid NOTES cases compared to the laparoscopic cases. This finding is consistent with previous research [2, 8, 10, 18, 19, 20, 21, 22]. For instance, our analysis indicates that the emergence of new substeps to setup the transvaginal access increased the surgical time suggesting the requirement of a specific training for general surgeons to improve their performance in this step.…”

Section: Discussionsupporting

confidence: 92%

“…A similar foundation called EURO-NOTES has also been established in Europe to support the research efforts for NOTES [17]. However, to date, only a few published studies have compared the conventional laparoscopic surgery to NOTES cholecystectomy, all with a focus on the clinical outcomes of each technique [2, 8, 10, 18, 19, 20, 21, 22]. A review of these studies shows that there is currently neither an agreement regarding the feasibility and safety of NOTES in direct comparison to conventional laparoscopic surgery, nor a common metric to compare the two techniques.…”

Section: Introductionmentioning

confidence: 99%

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Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

et al. 2014

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Background NOTES is an emerging technique for performing surgical procedures, such as cholecystectomy. Debate about its real benefit over the traditional laparoscopic technique is on-going. There have been several clinical studies comparing NOTES to conventional laparoscopic surgery. However, no work has been done to compare these techniques from a Human Factors perspective. This study presents a systematic analysis describing and comparing different existing NOTES methods to laparoscopic cholecystectomy. Methods Videos of endoscopic/laparoscopic views from fifteen live cholecystectomies were analyzed to conduct a detailed task analysis of the NOTES technique. A hierarchical task analysis of laparoscopic cholecystectomy and several hybrid transvaginal NOTES cholecystectomies was performed and validated by expert surgeons. To identify similarities and differences between these techniques, their hierarchical decomposition trees were compared. Finally, a timeline analysis was conducted to compare the steps and substeps. Results At least three variations of the NOTES technique were used for cholecystectomy. Differences between the observed techniques at the substep level of hierarchy and on the instruments being used were found. The timeline analysis showed an increase in time to perform some surgical steps and substeps in NOTES compared to laparoscopic cholecystectomy. Conclusion As pure NOTES is extremely difficult given the current state of development in instrumentation design, most surgeons utilize different hybrid methods – combination of endoscopic and laparoscopic instruments/optics. Results of our hierarchical task analysis yielded an identification of three different hybrid methods to perform cholecystectomy with significant variability amongst them. The varying degrees to which laparoscopic instruments are utilized to assist in NOTES methods appear to introduce different technical issues and additional tasks leading to an increase in the surgical time. The NOTES continuum of invasiveness is proposed here as a classification scheme for these methods, which was used to construct a clear roadmap for training and technology development.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

et al. 2014

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“…While many NOTES procedures are performed transvaginally [100,101], the transanal approach offers the ability to access the peritoneal cavity through the diseased organ itself and then incorporate the colotomy into the final anastomosis. Initial concerns regarding increased rates of infection, when accessing the peritoneum via the GI tract, have been disproved in animal transcolonic NOTES models, clinical TES trials and clinical trangastric NOTES trials [102][103][104][105][106].…”

Section: • • Laparoscopic Techniques and Natural Orifice Specimen Extramentioning

confidence: 99%

Future directions in surgery for colorectal cancer: the evolving role of transanal endoscopic surgery

2014

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The current standard of care for resectable rectal cancers is total mesorectal excision (TME), which is usually performed open or laparoscopically, however, both techniques are associated with high morbidity and mortality.• Transanal endoscopic surgery (TES) is appropriate for benign rectal lesions and low-risk T1 tumors (Sm1; well differentiated; no lymphovascular or perineural invasion, and no tumor budding; <3 cm in size; <30% bowel circumference; and anticipated 3-mm clear margin).• Promising data support the use of neoadjuvant chemoradiation in making more lesions amenable to TES.• TES could potentially become favored over more radical surgery for preoperatively staged T2 tumors after neoadjuvant treatment.• Criteria for 'watch-and-wait' approaches are in flux because TES may have a role as a macrobiopsy for determining postneoadjuvant therapy T-stage, since long-term oncologic outcomes for TES are more related to ypT-stage rather than pretreatment T-stage.• Increasing data support transanal natural orifice translumenal endoscopic surgery (NOTES) TME as an acceptable alternative to open and laparoscopic TME, with regards to oncologic and functional outcomes.• Treatment paradigms including transanal NOTES to perform sentinel-node biopsies may provide more accurate staging, and potentially eliminate the need for TME in some cases.• Transanal NOTES TME should only be performed in carefully selected patients by surgeons with extensive experience with TES, laparoscopic TME and intersphincteric resection.SUMMARY The morbidity associated with radical surgery for rectal cancer has launched a revolution in increasingly less-invasive methods of resection, including a recent resurgence in transanal endoscopic surgical approaches. The next evolution in transanal surgery for rectal cancer is natural orifice translumenal endoscopic surgery (NOTES). To date, 14 series of transanal NOTES total mesorectal excision (TME) for rectal cancer have been published (n = 76).For reprint orders, please contact: reprints@futuremedicine.com

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“…Contraindications also included deep endometriosis, suspected adnexal lesions, previous pelvic surgery, and a history of pelvic inflammatory disease. 17 After the first 4 successful hybrid NOTES operations were performed with no intra-or postoperative complications, patients with a history of previous pelvic and abdominal surgery or obesity were also considered to meet the candidacy criteria. One patient with a history of hysterectomy, and 4 patients with previous abdominal surgeries such as liver resection and cesarean section were also operated successfully.…”

Section: Contraindicationsmentioning

confidence: 99%

Transvaginal Laparoscopically-Assisted Endoscopic Appendectomy: A Major Hybrid Natural Orifice Transluminal Endoscopic Surgery Case Series in Asia

Khan

Liu

Niu

et al. 2016

International Surgery

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Transvaginal Natural Orifice Transluminal Endoscopic Surgery (Notes): Surgical Technique and Results

Cited by 4 publications

References 85 publications

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

Future directions in surgery for colorectal cancer: the evolving role of transanal endoscopic surgery

Transvaginal Laparoscopically-Assisted Endoscopic Appendectomy: A Major Hybrid Natural Orifice Transluminal Endoscopic Surgery Case Series in Asia

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