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Published on: September 11, 2021
Transesophageal NOTES--a critical analysis of relevant problems
Karl E Grund1, Thorsten G Lehmann
1Department for General, Visceral, and Transplantation Surgery, Surgical Endoscopy, University Hospital Tübingen, Waldhörnlestrasse 22, Tübingen, Germany. chir.endo@uni-tuebingen.de
Summary
Transesophageal Natural Orifice Transluminal Endoscopic Surgery (NOTES) shows potential but faces challenges. Further research must address critical surgical issues and species differences for clinical application.
Area of Science:
- Minimally Invasive Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Transesophageal access for Natural Orifice Transluminal Endoscopic Surgery (NOTES) is underexplored.
- This route offers unique insights into NOTES possibilities and limitations.
Purpose of the Study:
- To critically analyze existing literature on transesophageal NOTES.
- To identify challenges and areas for improvement in this surgical approach.
Main Methods:
- Literature review of published studies on transesophageal NOTES, primarily in porcine models.
- Analysis of access techniques, interventions, closure methods, and reported outcomes.
Main Results:
- High success rates for access (90%) and achieving surgical aims (92%).
- Technical success in closure (90%), with variable incision healing.
- Significant mortality (6-25%) and complication rates, with inadequate attention to thoracic surgical principles and sterility.
Conclusions:
- Transesophageal NOTES demonstrates technical feasibility but requires significant refinement.
- Further studies must address critical surgical aspects, species-specific anatomy/physiology, and infection control for clinical translation.
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