Natural orifice translumenal endoscopic surgery (NOTES) (patient information): Difference between revisions
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*NOTES Decreases the incidence of incisional hernias and postoperative adhesions. | *NOTES Decreases the incidence of incisional hernias and postoperative adhesions. | ||
*Anesthesia requirements in NOTES are relatively less than other types of surgery. | *Anesthesia requirements in NOTES are relatively less than other types of surgery. | ||
Theoretically, NOTES causes less immunosuppression for the patient than other surgical approaches | *Theoretically, NOTES causes less immunosuppression for the patient than other surgical approaches. | ||
Postoperative pulmonary and diaphragmatic function are better in NOTES procedures | *Postoperative pulmonary and diaphragmatic function are better in NOTES procedures. | ||
Better cosmetic results with the potential for scarless abdominal surgery | *Better cosmetic results with the potential for scarless abdominal surgery. | ||
NOTES may have an advantages in specific subpopulations. It can be performed in morbidly obese patients, in whom traditional access to the peritoneal cavity can be difficult because of abdominal wall thickness, thus an easy alternative in these patients. | *NOTES may have an advantages in specific subpopulations. It can be performed in morbidly obese patients, in whom traditional access to the peritoneal cavity can be difficult because of abdominal wall thickness, thus an easy alternative in these patients. | ||
*Patients usually do not need post-operative narcotic medications (analgesia). This may be due to the minimal trauma for the muscle fibers, nerves and skin by this kind of surgery. | |||
Patients usually do not need post-operative narcotic medications (analgesia). This may be due to the minimal trauma for the muscle fibers, nerves and skin by this kind of surgery | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 00:03, 5 April 2012
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Editor-In-Chief: Mohammed A. Sbeih, M.D. [1] Phone:617-849-2629
Synonyms and keywords: Natural orifice translumenal endoscopic surgery, Single incision laparoscopic surgery, Minimally invasive surgery, Transanal endoscopic microsurgery, Natural orifice surgery consortium for assessment and research, Society of american gastrointestinal and endoscopic surgeons.
Overview
Natural orifice translumenal endoscopic surgery (NOTES) is an experimental surgical technique whereby abdominal and thoracic operations can be performed without any scars, or with very tiny ones. The procedure is performed through a hollow organ by passing surgical instruments and a tiny camera through a natural orifice (mouth, urethra, anus, etc.). The patients recover more quickly and experience less pain and better cosmesis. The postoperative complications such as wound infections and hernias are significantly reduced. Animal models and cadavers have been used to demonstrate that NOTES procedures are safe and feasible. Some of the NOTES applications are abdominal cavity screening, internal organs biopsy, appendectomy, cholecystectomy, tubal ligation, gastrojejunostomy, partial hysterectomy, oophorectomy, colorectal resection and trans-esophageal myotomy.
Experimental Evolution
The evolving concept of natural orifice translumenal endoscopic surgery (NOTES) combines the techniques of minimally invasive surgery with flexible endoscopy. This permits performing certain procedures endoscopically by passing the endoscope and the surgical instruments through a natural orifice, then transluminally into areas that would not otherwise be accessible endoscopically (by the commonly used endoscope).
NOTES procedures have moved quickly from a concept to a therapeutic surgical approach based on many preclinical studies. These studies have demonstrated that several types of NOTES operations can be performed in animal survival models and human cadavers. NOTES procedures have been expanded in the last few years to cover a wide range of complex surgical operations by using the right translumenal route and suitable instrumentation.
Cholecystectomy, which is a high volume and relatively simple operation, has been the focus of most early NOTES research studies. NOTES Cholecystectomy has been performed successfully on many patients.
Recently, Robotic surgery has been investigated to be applied in NOTES procedures, a miniature in vivo robot has been developed for NOTES.
Advantages
Potential advantages of NOTES over other surgical methods include the following:
- There are faster recovery and shorter hospital stay in NOTES than laparoscopy or laparotomy procedures. Usually the patient is discharged on postoperative days 1 or 2 if the NOTES procedure has not been complicated.
- There is less physiologic insult in NOTES procedures than laparoscopy or laparotomy procedures.
- NOTES can avoid and minimize the potential complications of wound infections. Wound infection is a common surgical complication. Eliminating all skin incisions would eliminate the adverse impact of wound infection on the health care costs and patients' recovery.
- NOTES Decreases the incidence of incisional hernias and postoperative adhesions.
- Anesthesia requirements in NOTES are relatively less than other types of surgery.
- Theoretically, NOTES causes less immunosuppression for the patient than other surgical approaches.
- Postoperative pulmonary and diaphragmatic function are better in NOTES procedures.
- Better cosmetic results with the potential for scarless abdominal surgery.
- NOTES may have an advantages in specific subpopulations. It can be performed in morbidly obese patients, in whom traditional access to the peritoneal cavity can be difficult because of abdominal wall thickness, thus an easy alternative in these patients.
- Patients usually do not need post-operative narcotic medications (analgesia). This may be due to the minimal trauma for the muscle fibers, nerves and skin by this kind of surgery.