Current status and prerequisites for natural orifice translumenal endoscopic surgery (NOTES)

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Natural orifice translumenal endoscopic surgery (NOTES) has gained global traction since 2004.
• Despite numerous studies, NOTES is still considered experimental.
• A significant drawback is the lack of a reliable method for completely closing iatrogenic incisions in intraperitoneal organs.

Purpose of the Study:

• To highlight the challenges in Natural orifice translumenal endoscopic surgery (NOTES) adoption.
• To emphasize the need for improved closure techniques for lumenal incisions.
• To discuss ongoing research and development in NOTES at Kyushu University.

Main Methods:

• Review of existing literature on Natural orifice translumenal endoscopic surgery (NOTES).
• Examination of safety and usefulness of various closure devices in animal and clinical studies.
• Overview of advancements in endoscopic surgical techniques and technology, including navigation and robotics.

Main Results:

• Several devices for closing lumenal incisions have been developed and evaluated.
• Kyushu University is actively involved in training surgeons and developing advanced NOTES technologies.
• Ongoing research focuses on navigation systems and robotic technology to enhance NOTES procedures.

Conclusions:

• Complete closure of iatrogenic incisions is a critical unmet need for routine clinical adoption of NOTES.
• Advancements in endoscopy-related technologies, particularly robotics, are essential for the safe and widespread implementation of pure NOTES.