Natural Orifice Translumenal Endoscopic Surgery: Current Status

Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA.
Advances in Surgery 09/2009; 43(1):1-12. DOI: 10.1016/j.yasu.2009.02.001
Source: PubMed
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    • "Although it is natural to imagine that NOTES should result in less intense local and systemic inflammatory responses than conventional surgical approaches because no external incisions are performed, many questions remain unanswered concerning the real benefits that this new procedure could bring to patients (3). With NOTES, access to the peritoneal cavity is achieved by inserting a non-sterile endoscope through a hollow contaminated viscus such as the stomach or colon or through the vagina, with potential complications such as fistulas and infection (4). Research on inflammatory responses to surgery has frequently used cytokines (e.g., interleukin [IL]-6, IL-1β, IL-10 and TNF-α) and acute phase proteins (e.g., C-reactive protein [CRP]) as plasma biomarkers of the inflammatory response (5,6). "
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    ABSTRACT: To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy. This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). In the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1β, 6 and 10 and tumor necrosis factor-α. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h. All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1β, interleukin 10 and tumor necrosis factor-α levels were below the threshold of detection. The mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p<0.05), with no significant differences among the sham, laparoscopy and natural orifice transluminal endoscopic surgery groups (p>0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups. Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy.
    Full-text · Article · Nov 2013 · Clinics (São Paulo, Brazil)
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    • "Gathering the advantages of laparoscopy and NOTES, hybrid approaches have been described both in animals and in humans. This concept has been gaining momentum and is now progressing into surgical practice by showing increasing evidence of safeness in humans [8] [9] [10] [11] [12]. At the present time, the emerging issues are the feasibility, reliability, and indications of these new technical developments . "
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    ABSTRACT: One of the latest surgical innovations is natural orifice transluminal endoscopic surgery (NOTES). We hypothesize that the principles of NOTES could be applied to the laparoscopic Duhamel procedure. Between March 2008 and May 2010, 3 children underwent the laparoscopic Duhamel procedure assisted by transrectal NOTES. Three 5-mm transabdominal trocars were combined with a 12-mm transrectal trocar. We were able to safely apply the principles of NOTES, improving the performance of laparoscopic Duhamel pull-through using current instruments and technology. This new approach avoids the need of an extra transabdominal 12-mm trocar for the endoscopic stapler, allows an easier creation of a smaller rectal stump, and offers the possibility of an extra working port. This hybrid concept can be seen as a transition into the emerging field of NOTES in colorectal surgery.
    Full-text · Article · Oct 2012 · Journal of Pediatric Surgery
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    ABSTRACT: The advent of minimally invasive surgery and the advances in endoluminal flexible endoscopy have converged to generate a new concept in digestive surgery, whose acronym natural orifice transluminal endoscopic surgery (NOTES), has become a familiar term in the surgical community. NOTES has been performed through the mouth, the bladder, the rectum and the vagina. Of these four approaches, the vagina has gained most popularity for several reasons. It is not only readily accessible and easy to decontaminate but it also provides safe entry and simple closure. The transvaginal approach has been described in the experimental and the clinical setting as an option for cholecystectomy, nephrectomy, splenectomy, segmental gastrectomy, retroperitoneal exploration and bariatric surgery. However, larger series are needed to delineate the exact risks of this approach, and to transcend cultural barriers that impede its wider introduction. Prospective randomized trials will shed light on the definitive role of the vaginal approach in minimal invasive surgery of the future.
    Preview · Article · Jun 2010
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