Natural orifice translumenal surgery(NOTES) has garnished significant attention from surgeons and gastroenterologists,due to the fusion of flexible endoscopy and operative technique.Preliminary efforts suggest that NO...Natural orifice translumenal surgery(NOTES) has garnished significant attention from surgeons and gastroenterologists,due to the fusion of flexible endoscopy and operative technique.Preliminary efforts suggest that NOTES holds potential for a less invasive approach with certain surgical conditions.Many of the hurdles encountered during the shift from open to laparoscopic surgery are now being revisited in the development of NOTES.Physician directed efforts,coupled with industry support,have brought about several NOTES specific devices and platforms to help address limitations with current instrumentation.This review addresses current flexible platforms and their attributes,advantages,disadvantages and limitations.展开更多
AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on...AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on, with 17 as an acute experiment and 14 with a survival protocol. The animals were placed in a supine position and a 12-mm double-channel endoscope (Karl StorzTM, Tuttlingen) was used for vision and dissection. During the same time period, the access experiment was reproduced on 3 human cadavers using material similar to that used in the animal model. RESULTS: In the animal model, 37 interventions were done on the kidney, adrenal gland and pancreas. The mean time to fashion the access was 10 min (range 5 to 20 min). No intraoperative death was observed. Two major (5%) intraoperative complications occurred: one hemorrhage on the aorta and one tearing of the right renal vein. Peritoneal laceration was encountered in 5 cases without impairing the planned task. In the survival group, good clinical outcome was observed at a mean follow-up of 3 wk (range 2 to 6 wk). In the 3 cadavers, access was performed correctly. The mean time to fashion the access was 52 min (range 40 to 60 min). All the anatomical landmarks described in the pig model were clearly identified in the same sequence. CONCLUSION: A retroperitoneal natural orifice translumenal surgical transvaginal approach is feasible in both animal and human models and allows performance of a large panel of interventions.展开更多
Objective To give a conceptual description of natural orifice translumenal endoscopic surgery （NOTES）, review the early efforts in the NOTES field, and discuss its challenges and limitations. Data sources The data w...Objective To give a conceptual description of natural orifice translumenal endoscopic surgery （NOTES）, review the early efforts in the NOTES field, and discuss its challenges and limitations. Data sources The data were retrieved mainly from publications listed in MEDLINE, PubMed and China Wanfang Database from 2005 to 2009. The search term was ＂NOTES＂. Study selection The articles involved in the ＂NOTES＂ study were selected and the review articles were excluded from the comparison. Results A marked increase in quantity in articles was shown each year for NOTES studies from 2006 to 2009. Animal experiments with ＂NOTES＂ have been carried out in China from 2007, and two independent ＂NOTES＂ procedures on humans were reported in 2009. Conclusion Although still in its infancy, the ＂NOTES＂ procedure is promising as another type of minimally invasive surgery and favorable alternative to current interventions.展开更多
Clinical implementation and widespread application of natural orifice translumenal surgery(NOTES) has been limited by the lack of specialized endoscopic equipment,which has prevented the ability to perform complex pro...Clinical implementation and widespread application of natural orifice translumenal surgery(NOTES) has been limited by the lack of specialized endoscopic equipment,which has prevented the ability to perform complex procedures including colorectal resections.Relative to other types of translumenal access,transanal NOTES using transanal endoscopic microsurgery(TEM) prov ides a stable platform for endolumenal and direct translumenal access to the peritoneal cavity,and specifically to the colon and rectum.Completely NOTES transanal rectosigmoid resection using TEM,with or without transgastric endoscopic assistance,was demonstrated to be feasible and safe in a swine survival model.The same technique was successfully replicated in human cadavers using commercially available TEM,with endoscopic and laparoscopic instrumentation.This approach also permitted complete rectal mobilization with total mesorectal excision to be performed completely transanally.As in the swine model,transgastric and/or transanal endoscopic assistance extended the length of proximal colon mobilized and overcame some of the difficulties with TEM dissection including limited endoscopic visualization and maladapted instrumentation.This extensive laboratory experience with NOTES transanal rectosigmoid resection served as the basis for the first human NOTES transanal rectal cancer excision using TEM and laparoscopic assistance.Based on this early clinical experience,NOTES transanal approach using TEM holds significant promise as a safe and substantially less morbid alternative to conventional colorectal resection in the management of benign and malignant colorectal diseases.Careful patient selection and substantial improvement in NOTES instrumentation are critical to optimize this approach prior to widespread clinical application,and may ultimately permit completely NOTES transanal colorectal resection.展开更多
A new way of opening a body cavity can be a revolution in surgery.In 1980s,laparoscopy changed how surgeons had been working for years.Natural orifice translumenal endoscopic surgery(NOTES),minilaparoscopy-assisted n... A new way of opening a body cavity can be a revolution in surgery.In 1980s,laparoscopy changed how surgeons had been working for years.Natural orifice translumenal endoscopic surgery(NOTES),minilaparoscopy-assisted natural orifice surgery(MANOS),single incision laparoscopic surgery(SILS) and other new techniques are the new paradigm in our way of operating in the 21 st century.The development of these techniques began in the late 90s but they have not had enough impact to develop and evolve.Parallels between the first years of laparoscopy and NOTES can be made.Working for an invisible surgery,not only for cosmesis but for a less invasive surgery,is the target of NOTES,MANOS and SILS performed by surgeons and endoscopists over the last 10 years.The future flexible endoscopic platforms and the fusion between laparoscopic instruments and devices and robotic surgery will be a great advance for 'scarless surgery'.展开更多
In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development o...In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development of different laparoscopic instruments,production of various access ports,and improvement of operative endoscopes.The main advantages stimulating these two approaches are the cosmetic result,the rapid recovery of the patient,and the reduced need for pain killers.SALS and NOTES are in part complementary and in part alternative techniques.Currently,SALS is much simpler and technically easier than NOTES.展开更多
Since the concept of Natural Orifice Translumenal Endoscopic Surgery(NOTES) was introduced,it has continued to gain significantly in popularity and enthusiasm for its potential clinical applications.The ability to per...Since the concept of Natural Orifice Translumenal Endoscopic Surgery(NOTES) was introduced,it has continued to gain significantly in popularity and enthusiasm for its potential clinical applications.The ability to perform conventional laparoscopic and thoracoscopic procedures without the creation of scars and perhaps faster and less painful recovery has prompted a worldwide devotion to further this field.While intraabdominal NOTES has rapidly transitioned from animal models to human trials,applying the NOTES concept to perform thoracic procedures has been slower to gain momentum.The goal of this review is to summarize the current state of transesophageal NOTES thoracoscopy by looking at its potential for diagnostic and therapeutic interventions as well as the challenges in transitioning to human trials.展开更多
To review natural orifice translumenal endoscopic surgery (NOTES) applications in clinical practice and assess the evidence base for each application as reported in the literature.An electronic literature search was p...To review natural orifice translumenal endoscopic surgery (NOTES) applications in clinical practice and assess the evidence base for each application as reported in the literature.An electronic literature search was performed.Inclusion criteria were publications relating to NOTES applications in humans.For each type of operation the highest level of evidence available for clinical NOTES publications was evaluated.Morbidity and short-term operative outcomes were compared with gold standard published evidence where available.Finally,registered trials recruiting patients for NOTES applications were identified.Human NOTES publications with the highest level of evidence in each application are identified.There were no RCTs in the literature to date.The strongest evidence came in the form of large,multi-centre trials with 300-500 patients.The results are encouraging,comparable with gold standard techniques on morbidity and mortality.While short-term operative outcomes were also simi-lar when compared to the gold standard techniques,other than improved cosmesis little else can definitely be concluded as a clear benefit of a NOTES procedure.The most common procedures are cholecystectomy,appendicectomy and peritoneoscopy mainly performed via transvaginal access.It is evident that morbidity appears to be higher when the transgastric route is used.The safety profile of hybrid NOTES transvaginal procedures is beginning to be confirmed as is evident from the large number of procedures presented in this review.A number of authors have presented work on pure NOTES procedures but the results are inconsistent and thus the vast majority of NOTES procedures worldwide are performed in a hybrid fashion with a variable amount of laparoscopy.This review of the clinical applications of NOTES summarises the growing evidence behind this surgical discipline and highlights NOTES procedures with an acceptable safety profile.展开更多
文摘Natural orifice translumenal surgery(NOTES) has garnished significant attention from surgeons and gastroenterologists,due to the fusion of flexible endoscopy and operative technique.Preliminary efforts suggest that NOTES holds potential for a less invasive approach with certain surgical conditions.Many of the hurdles encountered during the shift from open to laparoscopic surgery are now being revisited in the development of NOTES.Physician directed efforts,coupled with industry support,have brought about several NOTES specific devices and platforms to help address limitations with current instrumentation.This review addresses current flexible platforms and their attributes,advantages,disadvantages and limitations.
文摘AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on, with 17 as an acute experiment and 14 with a survival protocol. The animals were placed in a supine position and a 12-mm double-channel endoscope (Karl StorzTM, Tuttlingen) was used for vision and dissection. During the same time period, the access experiment was reproduced on 3 human cadavers using material similar to that used in the animal model. RESULTS: In the animal model, 37 interventions were done on the kidney, adrenal gland and pancreas. The mean time to fashion the access was 10 min (range 5 to 20 min). No intraoperative death was observed. Two major (5%) intraoperative complications occurred: one hemorrhage on the aorta and one tearing of the right renal vein. Peritoneal laceration was encountered in 5 cases without impairing the planned task. In the survival group, good clinical outcome was observed at a mean follow-up of 3 wk (range 2 to 6 wk). In the 3 cadavers, access was performed correctly. The mean time to fashion the access was 52 min (range 40 to 60 min). All the anatomical landmarks described in the pig model were clearly identified in the same sequence. CONCLUSION: A retroperitoneal natural orifice translumenal surgical transvaginal approach is feasible in both animal and human models and allows performance of a large panel of interventions.
文摘Objective To give a conceptual description of natural orifice translumenal endoscopic surgery （NOTES）, review the early efforts in the NOTES field, and discuss its challenges and limitations. Data sources The data were retrieved mainly from publications listed in MEDLINE, PubMed and China Wanfang Database from 2005 to 2009. The search term was ＂NOTES＂. Study selection The articles involved in the ＂NOTES＂ study were selected and the review articles were excluded from the comparison. Results A marked increase in quantity in articles was shown each year for NOTES studies from 2006 to 2009. Animal experiments with ＂NOTES＂ have been carried out in China from 2007, and two independent ＂NOTES＂ procedures on humans were reported in 2009. Conclusion Although still in its infancy, the ＂NOTES＂ procedure is promising as another type of minimally invasive surgery and favorable alternative to current interventions.
文摘Clinical implementation and widespread application of natural orifice translumenal surgery(NOTES) has been limited by the lack of specialized endoscopic equipment,which has prevented the ability to perform complex procedures including colorectal resections.Relative to other types of translumenal access,transanal NOTES using transanal endoscopic microsurgery(TEM) prov ides a stable platform for endolumenal and direct translumenal access to the peritoneal cavity,and specifically to the colon and rectum.Completely NOTES transanal rectosigmoid resection using TEM,with or without transgastric endoscopic assistance,was demonstrated to be feasible and safe in a swine survival model.The same technique was successfully replicated in human cadavers using commercially available TEM,with endoscopic and laparoscopic instrumentation.This approach also permitted complete rectal mobilization with total mesorectal excision to be performed completely transanally.As in the swine model,transgastric and/or transanal endoscopic assistance extended the length of proximal colon mobilized and overcame some of the difficulties with TEM dissection including limited endoscopic visualization and maladapted instrumentation.This extensive laboratory experience with NOTES transanal rectosigmoid resection served as the basis for the first human NOTES transanal rectal cancer excision using TEM and laparoscopic assistance.Based on this early clinical experience,NOTES transanal approach using TEM holds significant promise as a safe and substantially less morbid alternative to conventional colorectal resection in the management of benign and malignant colorectal diseases.Careful patient selection and substantial improvement in NOTES instrumentation are critical to optimize this approach prior to widespread clinical application,and may ultimately permit completely NOTES transanal colorectal resection.
文摘 A new way of opening a body cavity can be a revolution in surgery.In 1980s,laparoscopy changed how surgeons had been working for years.Natural orifice translumenal endoscopic surgery(NOTES),minilaparoscopy-assisted natural orifice surgery(MANOS),single incision laparoscopic surgery(SILS) and other new techniques are the new paradigm in our way of operating in the 21 st century.The development of these techniques began in the late 90s but they have not had enough impact to develop and evolve.Parallels between the first years of laparoscopy and NOTES can be made.Working for an invisible surgery,not only for cosmesis but for a less invasive surgery,is the target of NOTES,MANOS and SILS performed by surgeons and endoscopists over the last 10 years.The future flexible endoscopic platforms and the fusion between laparoscopic instruments and devices and robotic surgery will be a great advance for 'scarless surgery'.
文摘In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development of different laparoscopic instruments,production of various access ports,and improvement of operative endoscopes.The main advantages stimulating these two approaches are the cosmetic result,the rapid recovery of the patient,and the reduced need for pain killers.SALS and NOTES are in part complementary and in part alternative techniques.Currently,SALS is much simpler and technically easier than NOTES.
文摘Since the concept of Natural Orifice Translumenal Endoscopic Surgery(NOTES) was introduced,it has continued to gain significantly in popularity and enthusiasm for its potential clinical applications.The ability to perform conventional laparoscopic and thoracoscopic procedures without the creation of scars and perhaps faster and less painful recovery has prompted a worldwide devotion to further this field.While intraabdominal NOTES has rapidly transitioned from animal models to human trials,applying the NOTES concept to perform thoracic procedures has been slower to gain momentum.The goal of this review is to summarize the current state of transesophageal NOTES thoracoscopy by looking at its potential for diagnostic and therapeutic interventions as well as the challenges in transitioning to human trials.
文摘To review natural orifice translumenal endoscopic surgery (NOTES) applications in clinical practice and assess the evidence base for each application as reported in the literature.An electronic literature search was performed.Inclusion criteria were publications relating to NOTES applications in humans.For each type of operation the highest level of evidence available for clinical NOTES publications was evaluated.Morbidity and short-term operative outcomes were compared with gold standard published evidence where available.Finally,registered trials recruiting patients for NOTES applications were identified.Human NOTES publications with the highest level of evidence in each application are identified.There were no RCTs in the literature to date.The strongest evidence came in the form of large,multi-centre trials with 300-500 patients.The results are encouraging,comparable with gold standard techniques on morbidity and mortality.While short-term operative outcomes were also simi-lar when compared to the gold standard techniques,other than improved cosmesis little else can definitely be concluded as a clear benefit of a NOTES procedure.The most common procedures are cholecystectomy,appendicectomy and peritoneoscopy mainly performed via transvaginal access.It is evident that morbidity appears to be higher when the transgastric route is used.The safety profile of hybrid NOTES transvaginal procedures is beginning to be confirmed as is evident from the large number of procedures presented in this review.A number of authors have presented work on pure NOTES procedures but the results are inconsistent and thus the vast majority of NOTES procedures worldwide are performed in a hybrid fashion with a variable amount of laparoscopy.This review of the clinical applications of NOTES summarises the growing evidence behind this surgical discipline and highlights NOTES procedures with an acceptable safety profile.
