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DOI: 10.1055/s-0030-1255794
© Georg Thieme Verlag KG Stuttgart · New York
Natural orifice transluminal endoscopic surgery
Publication History
Publication Date:
11 November 2010 (online)
This year, Digestive Disease Week (DDW; 1 – 5 May, New Orleans, Louisiana, USA) marked a decade of research and development into natural orifice transluminal endoscopic surgery (NOTES). Kalloo and Kantsevoy reported on the first NOTES procedure (transgastric peritoneoscopy) in a survival porcine model at DDW in 2000 [1], and 2 years later the same team presented an experimental series of tubal ligation in the pig model. At DDW 2002, Rao and Reddy also reported on the first human case (transgastric NOTES appendectomy) in a video session [2] [3].
During the first years of NOTES, there was tremendous interest in this technique, which was seen as a “prodigy child” of endoscopy and surgery. Numerous experimental studies have been published and clinical cases have been described, receiving important (and likely too early) coverage in the media [4]. Mixed endoscopy and laparoscopy research groups (e. g. NOSCAR [Natural Orifice Surgery Consortium for Assessment and Research] and EuroNOTES [a cooperation on NOTES between the European Association for Endoscopic Surgery (EAES) and the European Society of Gastrointestinal Endoscopy (ESGE)]) were established to promote safe development of research on NOTES from experimental studies to human clinical trials [5]. NOTES has continued to develop, and has changed from the initially described pure per-oral transgastric route performed by gastroenterologists in the pig model, to a procedure that is now mainly performed by surgeons, through the transvaginal route, with laparoscopic assistance in human patients.
According to a literature search carried out a couple of weeks before DDW 2010 by one of the presenters [6], 429 human NOTES cases have been published to date, including 316 transvaginal NOTES and 113 transgastric NOTES procedures, and most of them with laparoscopic assistance. Transvaginal cholecystectomy is the main indication that has developed (337 published cases), with several open series showing promising results. According to the same author, it is believed than approximately 1600 human NOTES cases have been performed throughout the world (> 900 in Europe, > 600 in South America, and approximately 50 each in North America and Asia). However, the growth and development curve of NOTES research seems now to have reached a plateau, with only 26 abstracts on the subject submitted to DDW 2010 compared with 78 abstracts on NOTES at DDW 2009 [7]. Most of this year’s abstracts are summarized below, according to their design and to the specific topic they cover. A total of 18 abstracts were presented as posters at four American Society for Gastrointestinal Endoscopy (ASGE) “New Technology” sessions and at one American Gastroenterological Association (AGA) “NOTES” session. Six communications were given during a single oral session entitled “NOTES: What’s the score?” Two communications on NOTES were displayed during a Society for Surgery of the Alimentary Tract (SSAT) video session.