Natural orifice transluminal endoscopic surgery: history and current development

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Endoscopy

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) aims to reduce surgical trauma, pain, and scarring by using natural orifices.
• Initial challenges included technical complexity and safe access closure, hindering widespread adoption.

Purpose of the Study:

• To review advancements in NOTES, including hybrid approaches and technological innovations.
• To assess the current clinical utility and future potential of NOTES in various gastrointestinal indications.

Main Methods:

• Review of current endoscopic techniques, closure devices, and hybrid NOTES approaches.
• Analysis of comparative studies between NOTES and traditional laparoscopy.
• Discussion of emerging technologies like robotics and AI in NOTES.

Main Results:

• Hybrid NOTES, especially transvaginal techniques, show reduced postoperative pain, faster recovery, and improved cosmesis.
• Innovations address previous limitations, enabling broader applications.
• Comparative studies indicate comparable safety and efficacy to laparoscopy, with enhanced patient comfort.

Conclusions:

• Advancements in techniques and technology are revitalizing NOTES' clinical utility.
• NOTES demonstrates significant patient benefits and comparable outcomes to laparoscopy.
• Future integration of robotics and AI, alongside structured training, is key for broader implementation.