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Quo vadis NOTES?

Quo vadis NOTES?

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Zusammenfassung

GRUNDLAGEN: Der Begriff NOTES® (Natural Orifice Translumenal Endoscopic Surgery) fasst neue Operationstechniken zusammen, die eine Synthese aus Endoskopie und Laparoskopie darstellen und keine sichtbaren Narben an der Körperoberfläche hinterlassen. METHODIK: Anhand der Literatur einerseits und eigenen Erfahrungen aus experimentellen und klinischen NOTES® Fällen andererseits, werden Geräte, Zugänge, Nahttechniken, Infektionsprophylaxe und Risiken angesprochen. ERGEBNISSE: NOTES® ist mittlerweile klinische Realität geworden. Über 300 Cholezystektomien an Patienten wurden bis Juli 2008 in mehreren Ländern unter Aufsicht der jeweiligen Ethikkomissionen durchgeführt. Die Operationsergebnisse entsprechen denen von traditioneller Laparoskopie, bei besserem kosmetischen Ergebnis. Es gibt Anzeichen, die auf geringeren postoperativen Schmerzmittelbedarf hindeuten, ob schnellere Rekonvaleszenz auch zu den Vorteilen von NOTES® gehört, bleibt abzuwarten. SCHLUSSFOLGERUNGEN: Flexible Laparoskopie und Thorakoskopie hat Zukunft. Abgesehen vom besseren kosmetischen Resultat, sind auch raschere Belastbarkeit der Bauchdecke postoperativ, sowie atraumatische Erreichbarkeit von Organen im Mediastinum ein Vorteil von NOTES® Instrumentarium. Ob mit diesen neuen Geräten dann ein translumenaler oder Single-Port-Zugang gewählt wird, können Patient und Arzt nach umfassender Aufklärung individuell entscheiden.

Summary

BACKGROUND: The term NOTES® (Natural Orifice Transluminal Endoscopic Surgery) summarizes new operation techniques, which are a synthesis of endoscopy and laparoscopy, and do not leave scars on patients' skin. METHODS: The article reviews the literature on the one hand and reflects our personal experience with experimental and clinical NOTES® cases on the other hand, discussing devices, approaches, tissue approximation techniques, prevention of infection, and risks. RESULTS: NOTES® has become a clinical reality. More than 300 human cases have been performed worldwide under IRB (Institutional Research Board) approval by July 2008. The results have been the same as if laparoscopy had been performed, with better cosmetic results. Some studies show a tendency towards lesser use of postoperative pain medication. It has to be proved if faster recovery is also an advantage of NOTES®. CONCLUSIONS: There is a future for flexible laparoscopy and thoracoscopy. NOTES® instruments provide better cosmetic results, leave the abdominal wall intact, and may have advantages for atraumatic surgery in the mediastinum. Patients and physicians can decide individually if the new available devices will be used in a transluminal or single port approach after intensive consideration of advantages and drawbacks of each access approach.

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Authors and Affiliations

  1. Minimally Invasive Surgery Program, Legacy Health System, Portland, Oregon, USA

    G. O. Spaun & L. L. Swanström

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  1. G. O. Spaun
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  2. L. L. Swanström
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Correspondence to L. L. Swanström.

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Spaun, G., Swanström, L. Quo vadis NOTES?. Eur Surg 40, 211–219 (2008). https://doi.org/10.1007/s10353-008-0428-7

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  • DOI: https://doi.org/10.1007/s10353-008-0428-7

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