Surgery Insight: natural orifice transluminal endoscopic surgery—an analysis of work to date

Abstract

Traditional flexible endoscopy has been limited to the confines of the gastrointestinal lumen; however, recent developments involving transluminal access to intra-abdominal structures hold the potential to revolutionize flexible endoscopy. Over the past few years various studies have detailed techniques that intentionally breach the lumen and provide endoscopic access to the peritoneal cavity for diagnostic and therapeutic procedures. Unlike standard surgical approaches, which require incisions to be made in the abdominal wall, natural orifice transluminal endoscopic surgery (NOTES) avoids the need for abdominal incisions and can offer specific advantages to select patient populations. Animal models have been used to demonstrate the possible applications of NOTES, including transgastric peritoneoscopy, tubal ligation, gastrojejunostomy, partial hysterectomy, oophorectomy, and transcolonic exploration, liver biopsy and cholecystectomy. In this Review, we highlight important advances in NOTES since it was first described and analyze the hazards and potential benefits associated with this innovative approach.

Key Points

• Endoscopic access to the peritoneal cavity via transgastric and transcolonic routes has been recently described in animal models and termed Natural Orifice Transluminal Endoscopic Surgery (NOTES)

• This 'scarless' surgery avoids abdominal incisions and could be advantageous in specific patient populations

• With improved endoscopic tools, NOTES could become an acceptable alternative and the preferred approach for management of certain abdominopelvic conditions in select cases

• The proposed benefits and safety of scarless access to the peritoneal cavity need to be conclusively demonstrated in clinical studies before universal acceptance of NOTES