Navigation systems and platforms in natural orifice translumenal endoscopic surgery (NOTES)

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Gastroenterology

Background:

• Natural orifice translumenal endoscopic surgery (NOTES) represents an advancement in minimally invasive surgery, aiming to eliminate skin incisions.
• Conventional endoscopes require modification for safe and efficient NOTES procedures.
• This review systematically examines specialized operating platforms for NOTES.

Purpose of the Study:

• To systematically review specialized operating platforms currently used or under development for NOTES procedures.
• To characterize available platforms, their availability, advantages, and disadvantages.

Main Methods:

• A comprehensive literature search was performed using Ovid EMBASE, Ovid MEDLINE, ISI Current Contents Connect, and PubMed up to December 1, 2008.
• Data extraction focused on characterizing navigation platforms and robotic systems for NOTES, including their features and limitations.

Main Results:

• Nine studies were reviewed, describing six navigation platforms and three robotic systems for NOTES.
• While platforms demonstrated desirable features like maneuverability, stability, and enhanced optics, no single platform emerged as clearly superior.
• Key functionalities such as triangulation and insufflation with suction/irrigation were noted in some systems.

Conclusions:

• Existing instruments are not optimally suited for the demands of NOTES surgery.
• Essential requirements for effective NOTES platforms include safe access, stable instrumentation channels, good visualization, proper insufflation/irrigation, and maneuverability.
• Collaboration between clinicians, engineers, and industry is crucial for developing optimal NOTES platforms.