Natural orifice trans-luminal endoscopic surgery (NOTES) in thoracic surgery

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Thoracic Surgery

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) initially focused on abdominal procedures.
• Recent interest has shifted towards mediastinal and thoracic applications of NOTES.
• Flexible endoscopy via natural orifices presents novel surgical possibilities.

Purpose of the Study:

• To survey the literature and author's experience with NOTES in thoracic and mediastinal surgery.
• To examine the feasibility and techniques of mediastinal and thoracoscopic flexible endoscopy.
• To discuss challenges and potential of NOTES in thoracic procedures.

Main Methods:

• Literature review of experimental and human use of NOTES in thoracic/mediastinal surgery.
• Examination of various access routes: transesophageal, transgastric, transvesicular, and percutaneous.
• Discussion of instrumentation, orientation, and access strategies.

Main Results:

• Direct transesophageal and submucosal flap access to mediastinum/pleural cavities are described.
• Transesophageal Heller myotomy shows early promise for clinical adoption.
• Per-oral endoscopic myotomy highlights the thorax as a key area for NOTES.

Conclusions:

• NOTES holds significant potential for thoracic and mediastinal surgery.
• The thorax may become a primary site for NOTES applications.
• Further development is needed, but early results are encouraging for incisionless thoracic procedures.