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Related Experiment Video

Updated: Jun 24, 2026

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
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Natural orifice surgery: initial clinical experience.

Santiago Horgan1, John P Cullen, Mark A Talamini

  • 1Department of Surgery, University of California San Diego, San Diego, CA 92103, USA.

Surgical Endoscopy
|April 4, 2009
PubMed
Summary
This summary is machine-generated.

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Natural orifice translumenal endoscopic surgery (NOTES) is feasible and safe, with an umbilical trocar assisting procedures. This approach enables safe and reproducible natural orifice operations until advanced instruments are developed.

Area of Science:

  • Minimally invasive surgery
  • Surgical innovation
  • Endoscopic procedures

Background:

  • Natural orifice translumenal endoscopic surgery (NOTES) has advanced rapidly from research to clinical application.
  • Clinical NOTES face challenges in safe access, organ manipulation, and securing critical structures.
  • This study addresses technical challenges encountered during initial clinical implementation of NOTES.

Purpose of the Study:

  • To identify and overcome technical challenges in clinical NOTES.
  • To develop solutions for safe and effective natural orifice operations.
  • To evaluate the feasibility and safety of initial clinical NOTES procedures.

Main Methods:

  • Procedures performed under IRB approval with patient consent.
  • Utilized transvaginal and transgastric approaches for gallbladder and appendix removal.

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Last Updated: Jun 24, 2026

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  • Employed a single umbilical trocar for safety and surgical assistance.

    • Main Results:

    • Successfully completed nine transvaginal cholecystectomies and two appendectomies (one transvaginal, one transgastric).
    • Most patients were discharged on postoperative day 1.
    • No complications were reported during the study period.

    Conclusions:

    • Initial clinical experience suggests NOTES is a feasible and safe surgical option.
    • An umbilical trocar serves as a crucial aid for safe NOTES procedures.
    • Innovations like flexible instruments and uterine manipulators enhance safety and reproducibility in NOTES.