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Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice

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Abstract

Background

Natural orifice translumenal endoscopic surgery (NOTES), with its focus on eliminating incision-related complications, promises to revolutionize the way surgery is performed. This study aimed to summarize the clinical applications of NOTES for humans, outline the techniques used, and discuss the complications and limitations of current techniques.

Methods

A literature search was performed using PubMed and Medline search tools to review the extent and outcomes of human procedures undertaken using the NOTES technique in its pure form or as a hybrid procedure reported until July 2008. The end points were the types of operation performed, the approach and technique used for each operation, and the procedure-related complications and technical limitations.

Results

This review considered 16 publications reporting on 49 human subjects. All the studies except three used hybrid NOTES procedures, with varying amounts of transabdominal assistance. Three transvaginal cholecystectomies, one transvaginal appendectomy, and eight transgastric appendectomies have been performed using a pure NOTES technique. To date, 15 NOTES transvaginal cholecystectomies and 10 NOTES appendectomies (8 transgastric and 2 transvaginal) are reported. Other procedures including peritoneoscopy and sigmoid colectomy are described. Three cases of minor morbidity are reported and no mortality.

Conclusions

Although initial human results seem encouraging, it is important that this research be conducted in a way that minimizes bad publicity and describes both favorable and adverse outcomes. Robust trials must be conducted at established centers with appropriate experience and institutional board ethical review to allow safe introduction of this novel technique, with adequate and expedient reporting of serious adverse events. The limitations of the current tools and methods are discussed, and suggestions are made for further improvements in the technology to facilitate NOTES operations.

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Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, 10th Floor QEQM, St. Mary’s Hospital, South Wharf Road, London, W2 1NY, USA

    Mikael H. Sodergren, James Clark, Thanos Athanasiou, Julian Teare & Ara Darzi

  2. Institute of Biomedical Engineering, Imperial College London, London, UK

    Guang-Zhong Yang

Authors
  1. Mikael H. Sodergren
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  2. James Clark
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  3. Thanos Athanasiou
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  4. Julian Teare
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  5. Guang-Zhong Yang
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  6. Ara Darzi
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Correspondence to Mikael H. Sodergren.

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Sodergren, M.H., Clark, J., Athanasiou, T. et al. Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice. Surg Endosc 23, 680–687 (2009). https://doi.org/10.1007/s00464-008-0278-1

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  • DOI: https://doi.org/10.1007/s00464-008-0278-1

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