Natural orifice transluminal endoscopic surgery

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.

References

• 1 Kalloo A N, Singh V K, Jagannath S B. et al . Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity.  Gastrointest Endosc. 2004;  60 114-117
• 2 Jagannath S B, Kantsevoy S V, Vaughn C A. et al . Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model.  Gastrointest Endosc. 2005;  61 449-453
• 3 Rao G V, Reddy D N, Banerjee R. NOTES: human experience.  Gastrointest Endosc Clin N Am. 2008;  18 361-370; x
• 4 Kantsevoy S V, Adler D G, Chand B. et al . Natural orifice translumenal endoscopic surgery.  Gastrointest Endosc. 2008;  68 617-620
• 5 ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery . White Paper October 2005.  Gastrointest Endosc. 2006;  63 199-203
• 6 Hungness E, Santos B, Milad M, Soper N. Hybrid Transvaginal NOTES cholecystectomy using a novel flexible toolbox and internal retraction system.  Digestive Disease Week. 2010, May 1 – 5;  New Orleans, Louisiana, USA Abstract
• 7 Delius S von, Meining A. Natural orifice transluminal endoscopic surgery (NOTES).  Endoscopy. 2010;  42 73-76
• 8 Renteln D von, Schmidt A, Vassiliou M. et al . Diagnostic laparoscopy for detection of intraperitoneal lesions and organ visualisation: a blinded, randomized controlled trial comparing transabdominal, transgastric and transcolonic peritoneoscopy.  Gastrointest Endosc. 2010;  71 AB236
• 9 Voermans R, van Berge Henegouwen M, de Cuba E. et al . Randomised, blinded comparison of transgastric, transcolonic and laparoscopic peritoneoscopy for the detection of peritoneal metastases in a human cadaver model.  Gastroenterology. 2010;  138 S667
• 10 Ladjici Y, Pocard M, Valleur P. et al . No incision (NOTES) vs single incision (SILS) surgery for access to elective sites of peritoneal carcinomatosis: back-to-back comparison in a live porcine model.  Gastrointest Endosc. 2010;  71 AB139
• 11 Ladjici Y, Pocard M, Marteau P. et al . Single port peritoneoscopy: be flexible! Results of a randomized controlled trial in a live porcine model translated to human cadavers.  Gastrointest Endosc. 2010;  71 AB238-AB239
• 12 Fyock C, Kirtane T, Forsmark C, Wagh M. Intraoperative NOTES endosonography and identification of mock hepatic lesions.  Gastrointest Endosc. 2010;  71 AB321
• 13 Voermans R P, van Berge Henegouwen M I, Bemelman W A, Fockens P. Feasibility of transgastric and transcolonic natural orifice transluminal endoscopic surgery peritoneoscopy combined with intraperitoneal EUS.  Gastrointest Endosc. 2009;  69 e61-e67
• 14 Fritscher-Ravens A, Ghanbari A, Cuming T. et al . Comparative study of NOTES alone vs. EUS-guided NOTES procedures.  Endoscopy. 2008;  40 925-930
• 15 Fernandez-Esparrach G, San Jose Estepar R, Guarner-Argente C. et al . The role of a CT-based image registered navigation system for natural orifice transluminal endoscopic surgery (NOTES): a comparative study in a porcine model.  Gastrointest Endosc. 2010;  71 AB317
• 16 Azagury D, Ryou M, Shaikh S. et al . Image registration in NOTES: use of real time CT-based augmented reality for NOTES(r) navigation and mapping of optimal NOTES access sites using kinematics in human cadavers.  Gastrointest Endosc. 2010;  71 AB138
• 17 Ryou M, Shaikh S, Ryan M. et al . Trans-esophageal NOTES surgery in a human cadaveric model augmented by a real-time three dimensional CT guidance system.  Gastroenterology. 2010;  138 S666-S667
• 18 Sugimoto M, Morita Y, Sanuki T. et al . Three dimensional image overlay navigation using magnetic endoscope detection system for NOTES and SILS.  Gastrointest Endosc. 2010;  71 AB318
• 19 Hookey L C, Khokhotva V, Bielawska B. et al . The Queen's closure: a novel technique for closure of endoscopic gastrotomy for natural-orifice transluminal endoscopic surgery.  Endoscopy. 2009;  41 149-153
• 20 Martinek J, Ryska O, Filipkova T. et al . “King” closure – a new method for full-thickeness gastrotomy closure using one Endoloop and clips.  Gastrointest Endosc. 2010;  71 AB348
• 21 Dray X, Mukkai Krishnamurty D, Donatelli G. et al . Gastric wall healing after NOTES procedures: endoscopic clips closure provide superior histological outcome comparing to threaded-tags closure.  Gastrointest Endosc. 2010;  72 343-350
• 22 Dot-Bach J, AbuSuboh Abadia M, Armengol Bertroli J. et al . Comparison of different over-the-scope devices for gastric incision closure post NOTES procedures.  Gastrointest Endosc. 2010;  71 AB322
• 23 Armengol Bertroli J, Dot-Bach J, AbuSuboh Abadia M. et al . Colonic wall closure with over-the-scope device: does it really provide adequate colonic healing?.  Gastrointest Endosc. 2010;  71 AB352
• 24 Sumiyama K, Gostout C J, Rajan E. et al . Endoscopic full-thickness closure of large gastric perforations by use of tissue anchors.  Gastrointest Endosc. 2007;  65 134-139
• 25 Swanstrom L L, Kozarek R, Pasricha P J. et al . Development of a new access device for transgastric surgery.  J Gastrointest Surg. 2005;  9 1129-1137
• 26 Guarner-Argente C, Cordova H, Martínez-Pallí G. et al . Natural orifice endoscopic surgery gastrotomy closure: a survival porcine study.  Gastrointest Endosc. 2010;  71 AB346
• 27 Fyock C, Forsmark C, Wagh M. Endoscopic management of visceral injuries during NOTES: a blinded study in a porcine model.  Gastrointest Endosc. 2010;  71 AB346-AB347
• 28 Fyock C, Forsmark C, Wagh M. The NOTES approach to management of inadvertent urinary bladder injury: a blinded study.  Gastrointest Endosc. 2010;  71 AB347
• 29 Bingener J, Michalek J, Winston J. et al . Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model.  Surg Endosc. 2008;  22 1430-1434
• 30 Matthes K, Lee S, Gromski M. et al . Continuous monitoring of hemodynamics during complex NOTES procedures.  Gastrointest Endosc. 2010;  71 AB348
• 31 Bergstrom M, Swain P, Park P O. Measurements of intraperitoneal pressure and the development of a feedback control valve for regulating pressure during flexible transgastric surgery (NOTES).  Gastrointest Endosc. 2007;  66 174-178
• 32 McGee M F, Rosen M J, Marks J. et al . A reliable method for monitoring intraabdominal pressure during natural orifice translumenal endoscopic surgery.  Surg Endosc. 2007;  21 672-676
• 33 Meireles O, Kantsevoy S V, Kalloo A N. et al . Comparison of intraabdominal pressures using the gastroscope and laparoscope for transgastric surgery.  Surg Endosc. 2007;  21 998-1001
• 34 Navarro-Ripoll R, Martínez-Pallí G, Guarner-Argente C. et al . Intermittent insufflation/desufflation during natural orifice transluminal endoscopic surgery (NOTES) can reduce wide variability on intraabdominal pressure, hemodynamics and respiratory function.  Gastrointest Endosc. 2010;  71 AB349
• 35 Dubcenco E, Grantcharov T, Streutker C. et al . A pilot study in a survival porcine model evaluating the feasibility and safety of adhesiolysis by using transgastric NOTES approach, waterjet technology and endoscopic instruments.  Gastrointest Endosc. 2010;  71 AB198
• 36 Merrifield B F, Wagh M S, Thompson C C. Peroral transgastric organ resection: a feasibility study in pigs.  Gastrointest Endosc. 2006;  63 693-697
• 37 Wagh M S, Merrifield B F, Thompson C C. Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model.  Gastrointest Endosc. 2006;  63 473-478
• 38 Martinek J, Ryska O, Filipkova T. et al . NOTES vs. laparoscopic ovarectomy: an experimental, randomized trial.  Gastrointest Endosc. 2010;  71 AB321-AB322
• 39 Kantsevoy S V, Jagannath S B, Niiyama H. et al . Endoscopic gastrojejunostomy with survival in a porcine model.  Gastrointest Endosc. 2005;  62 287-292
• 40 Mathew A, Gopal J, Yeasted N. et al . Successful development of a technique for an endoscopic gastroenterostomy utilizing the self-approximating translumenal access technique (STAT) in porcine survival experiments.  Gastrointest Endosc. 2010;  71 AB350
• 41 Gopal J, Mathew A, Moyer M. et al . The self-approximating translumenal access technique (STAT) for NOTES Heller myotomy in a porcine model.  Gastrointest Endosc. 2010;  71 AB139-AB140
• 42 Inoue H, Minami H, Kobayashi Y. et al . Peroral endoscopic myotomy (POEM) for esophageal achalasia.  Endoscopy. 2010;  42 265-271
• 43 Santos B, Hungess E, Auyang E, Soper N. Natural orifice translumenal endoscopic surgery (NOTES) retraction.  Digestive Disease Week. 2010, May 1 – 5;  New Orleans, Louisiana, USA Abstract
• 44 Laudanno O, Gollo P, Rondan A. et al . Transvaginal NOTES cholecystectomy: long term results.  Gastrointest Endosc. 2010;  71 AB198
• 45 Sumiyama K, Gostout C J, Rajan E. et al . Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy.  Gastrointest Endosc. 2006;  64 808-812
• 46 Bernhardt J, Schneider-Koriath S, Steffen H, Ludwig K. Real NOTES, hybrid and laparoscopic appendectomy in human: a prospective quality of life study comparing outcome after flexible NOTES appendectomy in hybrid technique and laparoscopic appendectomy.  Gastrointest Endosc. 2010;  71 AB138-AB139
• 47 Wang X, Zhang F, Lin J. et al . Transvaginal endoscopic salpingectomy treatment of oviduct pregnancy in humans.  Gastrointest Endosc. 2010;  71 AB208-0