[Natural orifice transluminal endoscopic surgery (NOTES): initial experimental results]

Area of Science:

• Minimally invasive surgery
• Endoscopic procedures
• Surgical innovation

Context:

• Natural orifice endoscopic surgery (NOTES) utilizes new prototypes and experimental animal models.
• A one-year surgical program was conducted in sows, adhering to European animal research guidelines.
• Ninety operations were performed to assess various aspects of NOTES procedures.

Purpose:

• To evaluate the complexity of different access routes in NOTES (transgastric, transvaginal, transesophageal, transumbilical).
• To assess support measures for spatial and temporal orientation during surgery.
• To determine the technical efficacy of various visceral orifice closure methods (clips, T-bars, Obesco clips, endoscopic suture).

Summary:

• Pneumoperitoneum with CO(2) enhances safety during entry.
• Controlling intra-abdominal hemorrhage remains a significant challenge.
• While clips have limitations, T-bars and Obesco clips show promise for leak-free orifice closure.
• Endoscopes enabling triangulation can aid dissection and suturing.

Impact:

• NOTES necessitates a collaborative team of laparoscopic and endoscopic surgeons.
• Pure NOTES presents considerable complexity.
• Hybrid NOTES or transumbilical routes may serve as practical intermediate steps towards widespread adoption.