Journal of Gastrointestinal Surgery

, Volume 13, Issue 8, pp 1401–1410 | Cite as

Surgeon Perceptions of Natural Orifice Translumenal Endoscopic Surgery (NOTES)

  • Eric T. VolckmannEmail author
  • Eric S. Hungness
  • Nathaniel J. Soper
  • Lee L. Swanstrom
SSAT Poster Presentation



If proven feasible and safe, Natural Orifice Translumenal Endoscopic Surgery (NOTES) would still need acceptance by surgeons if it were to become a mainstream approach.


Three hundred fifty-seven surgeons responded to a preliminary survey describing NOTES and were asked to rate the importance of various surgical considerations and (assuming availability and safety) if they would choose to undergo and/or perform cholecystectomies by NOTES or laparoscopy and why.


The risk of having a complication was considered most important. NOTES was theorized to be riskier and to require greater skill than laparoscopy but to potentially cause less pain and convalescence. Nearly three-fourths (72%) of surgeons expressed interest in NOTES training which correlated with younger age, SAGES membership, minimally invasive surgery specialization, and flexible endoscopic volume. Forty-four percent would like to introduce NOTES cholecystectomy into their practices. Among those not preferring NOTES, 88% would adopt NOTES if data showed improved outcomes over laparoscopy. Finally, only 24% would choose to undergo cholecystectomy themselves by NOTES, believing it to be too new and riskier than laparoscopy.


The risk of having a complication is the greatest concern among surgeons, and safety will affect NOTES acceptance.


The results of this survey seem to justify more focused future investigations.


NOTES Flexible endoscopy New technology Surgery Attitude of health personnel 



The authors would like to thank Joseph Feinglass, PhD, Research Associate Professor, Division of General Internal Medicine, Northwestern University Medical School for his assistance with the statistical analysis of the data collected in this study.


  1. 1.
    Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004;60:114–117. doi: 10.1016/S0016-5107(04)01309-4.CrossRefPubMedGoogle Scholar
  2. 2.
    ASGE. SAGES: ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery White Paper October 2005. Gastrointest Endosc 2006;63:199–203. doi: 10.1016/j.gie.2005.12.007.CrossRefGoogle Scholar
  3. 3.
    Bernhardt J, Gerber B, Schober H-C, Kähler G, Ludwig K. NOTES—case report of a unidirectional flexible appendectomy. Int J Colorectal Dis 2008;23(5):547–550.CrossRefPubMedGoogle Scholar
  4. 4.
    Bessler M, Stevens PD, Milone L, Parikh M, Fowler D. Transvaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery. Gastrointest Endosc 2007;66:1243–1245. doi: 10.1016/j.gie.2007.08.017.CrossRefPubMedGoogle Scholar
  5. 5.
    Branco AW, Filho AJB, Kondo W, Noda RW, Kawahara N, Camargo AAH, Stunitz LC, Valente J, Rangel M. Hybrid transvaginal nephrectomy. Eur Urol 2008;53(6):1290–1294.CrossRefPubMedGoogle Scholar
  6. 6.
    Branco Filho AJ, Noda RW, Kondo W, Kawahara N, Rangel M, Branco AW. Initial experience with hybrid transvaginal cholecystectomy. Gastrointest Endosc 2007;66:1245–1248. doi: 10.1016/j.gie.2007.10.003.CrossRefPubMedGoogle Scholar
  7. 7.
    Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 2007;142:823–826. doi: 10.1001/archsurg.142.9.823 see comment. discussion 826–827.CrossRefPubMedGoogle Scholar
  8. 8.
    Swanstrom LL, Volckmann E, Hungness E, Soper NJ. Patient attitudes and expectations regarding natural orifice translumenal endoscopic surgery. Surg Endosc 2009; in pressGoogle Scholar
  9. 9.
    Windsor JA, McCay H. Inguinal hernia repair by laparoscopic surgeons: early experience and attitudes. Aust N Z J Surg 1995;65:470–474. doi: 10.1111/j.1445-2197.1995.tb01788.x.CrossRefPubMedGoogle Scholar
  10. 10.
    Escarce JJ. Externalities in hospitals and physician adoption of a new surgical technology: an exploratory analysis. J Health Econ 1996;15:715–734. doi: 10.1016/S0167-6296(96)00501-2.CrossRefPubMedGoogle Scholar
  11. 11.
    Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Diffusion of laparoscopic cholecystectomy among general surgeons in the United States. Med Care 1995;33:256–271. doi: 10.1097/00005650-199503000-00005.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Eric T. Volckmann
    • 1
    Email author
  • Eric S. Hungness
    • 1
  • Nathaniel J. Soper
    • 1
  • Lee L. Swanstrom
    • 2
  1. 1.Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of SurgeryLegacy Health System and Oregon Health Sciences UniversityPortlandUSA

Personalised recommendations