Natural Orifice Translumenal Endoscopic Surgery: A Critical Review
First Online: 05 December 2007 Received: 17 October 2007 Accepted: 07 November 2007 DOI:
Cite this article as: Pearl, J.P. & Ponsky, J.L. J Gastrointest Surg (2008) 12: 1293. doi:10.1007/s11605-007-0424-4 Abstract
Natural orifice translumenal endoscopic surgery (NOTES) involves the intentional puncture of one of the viscera (e.g., stomach, rectum, vagina, urinary bladder) with an endoscope to access the abdominal cavity and perform an intraabdominal operation. Early laboratory work focused on feasibility studies, including such accomplishments as pure transgastric splenectomy and gastrojejunostomy. Contemporary laboratory work is investigating the infectious and immunologic implications of NOTES and honing the tools and techniques required for complex abdominal operations. Today NOTES has entered the clinical arena in a few cases: the first clinical series of transgastric peritoneoscopy has recently been published; multiple groups are accumulating patients in studies of NOTES cholecystectomy, either via the transgastric or transvaginal route; and a series of transgastric appendectomies has been well publicized, yet it remains unpublished. Although clinical NOTES is gaining momentum, the field should remain in check while rigorous laboratory work is performed and cogent clinical trials are undertaken. The zeal for NOTES should not take precedence over the welfare of the patient.
Keywords Endoscopic surgery Intraabdominal Translumenal Peritoneoscopy Cholecystectomy References
Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004;60(1):114–117.
McGee MF, Rosen MJ, Marks J, et al. A primer on natural orifice transluminal endoscopic surgery: Building a new paradigm. Surg Innov 2006;13(2):86–93.
McGee M, Marks J, Onders R, et al. Infectious complications of natural orifice translumenal endoscopic surgery with percuatneous endoscopic gastrostomy tube closure: A quantitative bacteriologic study in the porcine model. Surg Endosc 2007;21(Supplement):S333.
Rattner D, Kalloo A. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. Surg Endosc 2006;20(2):329–333.
Jagannath SB, Kantsevoy SV, Vaughn CA, et al. Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 2005;61(3):449–453.
Kantsevoy SV, Jagannath SB, Niiyama H, et al. Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 2005;62(2):287–292.
Kantsevoy SV, Hu B, Jagannath SB, et al. Transgastric endoscopic splenectomy: Is it possible? Surg Endosc 2006;20(3):522–525.
Sumiyama K, Gostout CJ, 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(5):808–812.
Pai RD, Fong DG, Bundga ME, et al. Transcolonic endoscopic cholecystectomy: A NOTES survival study in a porcine model (with video). Gastrointest Endosc 2006;64(3):428–434.
Wagh MS, Merrifield BF, Thompson CC. Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 2006;63(3):473–478.
Clayman RV, Box GN, Abraham JB, et al. Transvaginal single-port NOTES nephrectomy: Initial laboratory experience. J Endourol 2007;21(6):640–644.
Minitz Y, Cullen, J, Falor, E, Talamini, MA. Dual Lumen NOTES: A new method for performing a safe anastomosis. Surg Endosc 2007;21(Suppl 1):S333.
Tsunada S, Ogata S, Ohyama T, et al. Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips. Gastrointest Endosc 2003;57(7):948–951.
Marks J, McGee MF, Onders R, et al. Complete endoscopic closure of gastrotomy following natural orifice translumenal endoscopic surgery using the NDO Plicator. Surg Endosc 2007; 21(Supplement):S333.
McGee MF, Marks JM, Onders RP, et al. Complete endoscopic closure of gastrotomy after natural orifice translumenal endoscopic surgery using the NDO Plicator. Surg Endosc 2007: DOI
Mellinger JD, MacFadyen BV, Kozarek RA, et al. Initial experience with a novel endoscopic device allowing intragastric manipulation and plication. Surg Endosc 2007;21(6):1002–1005.
Moyer MT, Pauli EM, Haluck RS, Mathew A. A Self-Approximating Transluminal Access Technique (STAT) for Potential use in NOTES: An ex vivo Porcine Model. Gastrointest Endosc 2007;65(5):AB293.
Moyer MT, Pauli EM, Haluck RS, Mathew A. A self-approximating transluminal access technique for potential use in NOTES: An ex vivo porcine model (with video). Gastrointest Endosc 2007.
Cios TJ, Reavis KM, Renton DR, Hazey JW, Mikami DJ, Allemand MT, Davis SS, Paul CM, Melvin WS. Sucessful closure of gastrotomy using bioabsorbable plugs in a canine model. Surg Endosc 2007;2007(Suppl 1):S333.
Cios TJ, Reavis KM, Renton DR, et al. Gastrotomy closure using bioabsorbable plugs in a canine model. Surg Endosc 2007; DOI
McGee MF, Rosen MJ, Marks J, et al. A reliable method for monitoring intraabdominal pressure during natural orifice translumenal endoscopic surgery. Surg Endosc 2007;21(4):672–676.
Scott DJ, Tang SJ, Fernandez R, et al. Completely transvaginal cholecystectomy using magnetically anchored instruments. Surg Endosc 2007;21(Supplement):S335.
Scott DJ, Tang SJ, Fernandez R, et al. Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments. Surg Endosc 2007;21(12):2308–2316.
Swanstrom LL, Kozarek R, Pasricha PJ, et al. Development of a new access device for transgastric surgery. J Gastrointest Surg 2005;9(8):1129–1136; discussion 1136–1137.
Sumiyama K, Gostout CJ, Rajan E, et al. Transgastric cholecystectomy: Transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope. Gastrointest Endosc 2007;65(7):1028–1034.
Mintz Y, Horgan S, Cullen J, et al. NOTES: The hybrid technique. J Laparoendosc Adv Surg Tech A 2007;17(4):402–406.
Whiteford MH, Denk PM, Swanstrom LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 2007;21(10):1870–1874.
Bahari HM, Ismail A. Endoscopic transgastric drainage of pseudopancreatic cyst. Med J Malays 1982;37(4):316–317.
Seifert H, Wehrmann T, Schmitt T, et al. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 2000;356(9230):653–655.
Gauderer MW, Ponsky JL, Izant RJ, Jr. Gastrostomy without laparotomy: A percutaneous endoscopic technique. J Pediatr Surg 1980;15(6):872–875.
Grady D. Doctors Try New Surgery for Gallbladder Removal. Accessed at
on October 14, 2007.
Bessler M, Stevens PD, Milone L, et al. Transvaginal laparoscopically assisted endoscopic cholecystectomy: A hybrid approach to natural orifice surgery. Gastrointest Endosc 2007 (e-pub ahead of print).
Hazey JW, Narula VK, Renton DB, et al. Natural-orifice transgastric endoscopic peritoneoscopy in humans: Initial clinical trial. Surg Endosc 2007; DOI
Marks J, Ponsky JL, Pearl JP, McGee MF. PEG Rescue: A NOTES technique. Surg Endosc 2007;21(5):816–819.
Marescaux J, Dallemagne B, Perretta S, et al. Surgery without scars: Report of transluminal cholecystectomy in a human being. Arch Surg 2007;142(9):823–826; discussion 826–827.
Ponsky JL. Gastroenterologists as surgeons: What they need to know. Gastrointest Endosc 2005;61(3):454.
Sivak MV. Gastrointestinal endoscopy: Past and future. Gut 2006;55(8):1061–1064.
Onders R, McGee MF, Marks J, et al. Diaphragm pacing with natural orifice transluminal endoscopic surgery: Potential for difficult-to-wean intensive care unit patients. Surg Endosc 2007;21:475–479.
Onders RP, McGee MF, Marks J, et al. Natural orifice transluminal endoscopic surgery (NOTES) as a diagnostic tool in the intensive care unit. Surg Endosc 2007;21(4):681–683.
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