[NOTES in visceral surgery : Current status].

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Innovation

Background:

• The concept of using natural orifices for surgical access aimed to reduce invasiveness beyond laparoscopic surgery.
• Early expectations for Natural Orifice Transluminal Endoscopic Surgery (NOTES) were tempered by technical limitations in available endoscopes.
• Challenges included sterility, infection control, tissue handling, access site closure, and specimen retrieval.

Purpose of the Study:

• To evaluate the feasibility and impact of natural orifice transluminal endoscopic surgery (NOTES).
• To explore the evolution of surgical access towards less invasive modalities.
• To assess the integration of NOTES principles into current surgical practices.

Main Methods:

• Review of initial experimental studies on NOTES feasibility.
• Analysis of challenges encountered in early NOTES procedures.
• Observation of the development of hybrid NOTES approaches and their clinical adoption.

Main Results:

• Initial NOTES procedures faced significant technical and safety hurdles, preventing widespread clinical adoption.
• The philosophy of NOTES has driven innovation, leading to reduced trocar usage in laparoscopic surgery.
• Hybrid NOTES procedures, combining laparoscopic and endoscopic techniques (often transvaginal), are now established in clinical practice.

Conclusions:

• While pure NOTES faced limitations, its underlying philosophy has significantly influenced surgical advancements.
• Hybrid NOTES represents a successful integration of endoscopic techniques into mainstream surgery.
• This evolution aligns with the ongoing trend towards less invasive surgical interventions and enhanced endoscopic capabilities.