Natural orifice translumenal endoscopic surgery (NOTES) (patient information)
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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.