[Robotic surgery and NOTES--Natural Orifice Translumenal Endoscopic Surgery in treatment of...

At the beginning of 90th years of the last century a laparoscopy technique initiated a new chapter in surgical treatment becoming the realistic alternative of classical laparotomies. Nowadays, after 20. years from first laparoscopic cholecystectomy new treatment methods such as Natural Orifice Translumenal Endoscopic Surgery (NOTES) and robotic surgery are gaining more and more great interest. The first robots created in the middle of 90 years were used only for keeping a camera and they were steered with voice, however with the development of technology was possible constructing precise machines, which were able to carry complicated procedures out (fundoplication, gastrectomy or colectomy), also from a long distance. At present two types of robots are being applied in the medical practice: da Vinci and Zeus. NOTES is a method that make possible to perform operations trough natural orifice of the body with an endoscope and appropriate instrumentation. Actually three fundamental ways of reaching the peritoneum are being used: through the stomach, through the rectum and through the vagina. Some authors tried also to use transbladder approach. The main advantage of the NOTES technique is a possibility of performing the procedure without necessity of cutting the abdominal wall, what decreases postoperative pain, eliminates the problem of an infecting wound, minimizes risk of postoperative hernias and reduces amount of postoperative adhesions. Problems related to the NOTES technique are mostly need of inventing new and better equipment, assurance tightness of the surgical access, development of an efficient antiseptic prophylaxis and also standardize learning methods. Dynamic development of the NOTES method allows overcoming some of these limitations by using innovative technical solutions and new systems e.g. TULA, NOTUS, ShapeLock, ViaCath, MAGS and many others. The aim of this study is a deep analysis of the recent technical solutions, rules of the therapy and schedules of management valid in the NOTES method and the robotic surgery suggested by the leading clinics. The article is also an attempt to answer the question if this new surgical procedures become as great revolution as laparoscopy.