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European Surgery

, Volume 40, Issue 3, pp 103–110 | Cite as

NOTES Techniques: present and future

  • B. W. MiedemaEmail author
  • J. A. Astudillo
  • E. Sporn
  • K. Thaler
Main Topic

Summary

BACKGROUND: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a promising approach to decrease surgical morbidity. However, the techniques and instrumentation are still primitive, requiring major modifications for use in NOTES procedures. METHODS: Review of the literature, personal communications and experiences. RESULTS: The operating room environment need to change with a larger sterile field and long sterile tables to accommodate long flexible instruments. Operating systems need to be improved to allow surgeons to have free ergonomic-friendly movements with long instruments. Modified endoscopes or flexible overtubes are required to provide a stable site of dissection at the end of a long flexible tube. Graspers need to be developed that are accurate and robust at a long distance from the operator. Tissue dissection through a flexible channel (ideally ultrasonic) will allow more complex NOTES procedures. Techniques of tissue closure and anastomosis are primitive and need to reach the standard seen with laparoscopic surgery. CONCLUSIONS: It is our judgment that NOTES will play a pivotal role in GI surgery. A general, coordinated effort will probably make NOTES a widespread reality.

Keywords

NOTES Transluminal Minimally invasive surgery Endoscopy Innovation 

NOTES-Technologien – derzeitiger Stand und Blick in die Zukunft

Zusammenfassung

GRUNDLAGEN: Technische Vorraussetzungen und Instrumentarium für NOTES (Natural Orifice Transluminal Endoscopic Surgery) stecken noch immer in ihren Kinderschuhen. METHODIK: Literaturübersicht, persönliche Erfahrungen und Expertenmeinungen. ERGEBNISSE: Sterilität von Endoskopen und der dazugehörigen Instrumente machen Adaptationen im Operationssaal erforderlich. Die Modifikation von herkömmlichen Endoskopen, die Entwicklung von flexiblen Overtubes, ergonomischen Arbeitsplattformen und von endoskopische Instrumenten, die gut steuerbar und trotzdem stabil sind, ist die Grundvoraussetzung zur sicheren Etablierung von NOTES. Endoskopische Verschluss- und Anastomosentechniken müssen weiterentwickelt werden, um den Standards der laparoskopischen Chirurgie gerecht zu werden. SCHLUSSFOLGERUNGEN: Wir glauben, dass NOTES eine bedeutende Rolle in der Chirurgie des Gastrointestinaltraktes spielen wird. Ein koordiniertes, kontrollierte Vorgehen ist nötig, um NOTES zur Realität werden zu lassen.

Schlüsselwörter

NOTES Transluminal Minimal-invasive Chirurgie Endoskopie Innovation 

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • B. W. Miedema
    • 1
    Email author
  • J. A. Astudillo
    • 1
  • E. Sporn
    • 1
  • K. Thaler
    • 1
  1. 1.Department of SurgeryUniversity of MissouriColumbiaUSA

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