Inpatients and specialists' opinions about natural orifice translumenal endoscopic surgery

In the last three years, investigations on natural orifice translumenal endoscopic surgery (NOTES) have entered the clinical experimental phase. Our aim was to carry out the first cross-sectional survey in Hungary about inpatients and specialists' opinions concerning natural orifice surgery. A total of 155 patients were included in the survey from two hospitals. Patients received a handout that described in detail the various available techniques for cholecystectomy, plus a 10-item questionnaire. Respondents had to choose between undergoing laparoscopic or NOTES cholecystectomy, indicate the acceptable complication rate, provide the reason for their choice, and select an ideal orifice. Specialists attending lectures on NOTES at two Hungarian congresses were given a separate questionnaire that was designed for physicians. We measured their perceptions about the need for the new method and about the unsolved issues it involved, their choice of entry site, their assessment of which type of specialist should perform NOTES operations, and the timeframe that would be needed for the widespread adoption of the method. With complication rates presumed to be equivalent to each other, 53% of inpatients chose a NOTES operation over laparoscopy for a cholecystectomy. Those who had prior endoscopy (p = 0.03), prior open surgery (p = 0.03), or who were male (p = 0.05) were more likely to opt for NOTES. The preferred approach was transvaginal (49%) for women, and transcolonic (66%) for men. Regarding the specialists, 37% would like to use NOTES in their practice and 49% would undergo a NOTES procedure; of these, 43% were unable to indicate the ideal orifice, 22% preferred the vagina, 20% the stomach, and 15% a hybrid approach. A total of 54% of surgeons believed that there is a real demand for NOTES, whereas 37% felt that it is an unnecessary innovation.