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Surgical Endoscopy

, Volume 22, Issue 3, pp 600–604 | Cite as

Developing essential tools to enable transgastric surgery

  • L. L. SwanstromEmail author
  • M. Whiteford
  • Y. Khajanchee
Article

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) is a largely theoretical but potentially exciting evolution of minimally invasive surgical care. Using technology borrowed from current diagnostic and therapeutic flexible endoscopy, the idea is to replicate current laparoscopic procedures in an “incisionless” manner. It is widely recognized that for NOTES to become a practical reality, many issues need to be resolved, both methodologic and political. One critical element of development will be the design of appropriate instrumentation for NOTES. This is currently happening and involves a complex collaboration between industry and clinicians both to adapt current equipment and to design and create new tools to enable the performance of transluminal procedures. This article describes the current process of such technology development as well as the resulting instrumentation that enables the performance of NOTES. The issues of access and platform stability, laparoscopic-like instruments, and secure tissue approximation are described, and the devices to solve these issues are detailed.

Keywords

Flexible endoscopy Innovation Medical devices New technology NOTES Surgery 

Notes

Acknowledgment

Dr Swanstrom serves as an advisor and receives research support from USGI Medical and Olympus Endoscopy.

Supplementary material

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References

  1. 1.
    Chand B, Felsher J, Ponsky J (2003) Future trends in flexible endoscopy. Semin Laparosc Surg 10:49–54PubMedGoogle Scholar
  2. 2.
    Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117PubMedCrossRefGoogle Scholar
  3. 3.
    Swanstrom LL, Kozarek R, Pasricha PJ, Gross S, Birkett D, Park PO, Saadat V, Ewers R, Swain P (2005) Development of a new access device for transgastric surgery. J Gastrointest Surg 9:1129–1136PubMedCrossRefGoogle Scholar
  4. 4.
    Rattner D, Kalloo AN, ASGE/SAGES Working Group (2006) ASGE/SAGES Working Group on Natural Orifice Transluminal Endoscopy. Gastrointest Endosc 63:199–203CrossRefGoogle Scholar
  5. 5.
    Ridwelski K, Pross M, Schubert S, Wolff S, Gunther T, Kahl S, Lippert H (2002) Combined endoscopic intragastral resection of a posterior stromal gastric tumor using an original technique. Surg Endosc 16:537PubMedCrossRefGoogle Scholar
  6. 6.
    Vitale GC, Davis BR, Tran TC (2005) The advancing art and science of endoscopy. Am J Surg 190:228–233PubMedCrossRefGoogle Scholar
  7. 7.
    Hu B, Chung SC, Sun LC, Lau YJ, Kawashima K, Yamamoto T, Cotton PB, Gostout CJ, Hawes RH, Kaloo An, Kantsevoy SV, Pasricha PJ (2005) Endoscopic suturing without extracorporeal knots: a laboratory study. Gastrointest Endosc 62:230–233PubMedCrossRefGoogle Scholar
  8. 8.
    Sclabas G, Swanstrom LL (2006) Secure closure methods in NOTES. Surg Innovation 13:23–30CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Division of Minimally Invasive SurgeryLegacy Health System, Oregon Health Sciences UniversityPortlandUSA
  2. 2.Colorectal SurgeryThe Oregon ClinicPortlandUSA
  3. 3.Department of Research and Division of Minimally Invasive SurgeryLegacy Health SystemPortlandUSA

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