Natural orifice translumenal endoscopic surgery (NOTES(®)): a technical review

Area of Science:

• Minimally invasive surgery
• Gastroenterology
• Surgical innovation

Background:

• The body of clinical Natural Orifice Transluminal Endoscopic Surgery (NOTES) literature is expanding.
• This review synthesizes published human NOTES experience, details instrument utilization, and compiles perioperative outcomes.

Purpose of the Study:

• To quantify published human NOTES experience.
• To examine instrument use in NOTES procedures.
• To compile available perioperative outcomes data for NOTES.

Main Methods:

• Systematic review of PubMed articles detailing human NOTES cases.
• Exclusion of diagnostic, specimen extraction, fluid drainage, and gynecological procedures.
• Cataloging technical details and performing frequency analysis of instrument use.

Main Results:

• Analysis of 432 operations across transvaginal, transgastric, transesophageal, and transrectal routes, predominantly hybrid transvaginal cholecystectomies.
• Variability observed in endoscope choice and access techniques for transvaginal procedures, often requiring rigid and transabdominal instruments.
• Standardized vaginotomy closure but consistent flexible endoscope, access, and closure techniques for transgastric procedures.

Conclusions:

• The hybrid transvaginal approach is most common in NOTES.
• While certain aspects show standardization, significant technical variability persists.
• Further outcomes data with standardized reporting are crucial for assessing NOTES risks and benefits.