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Critical analysis of hot topics in NOTES

Nature Reviews Gastroenterology & Hepatology volume 8, pages 565–572 (2011)Cite this article

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Abstract

Natural orifice transluminal endoscopic surgery (NOTES) has gained a great deal of attention from gastroenterologists and surgeons all over the world since its introduction in 2000. The field of NOTES has advanced tremendously since that time and exciting and well-designed research has been reported. Both randomized controlled trials and results from large national and international registries have been published. Many experimental and clinical studies have discussed transesophageal, transgastric, transvaginal and transrectal access for a variety of NOTES procedures. Transvaginal access has been the most frequently reported NOTES access route in clinical trials. When suitable instruments become available, a true comparison of NOTES with current laparoscopic approaches can be realized.

Key Points

  • Natural orifice transluminal endoscopic surgery (NOTES) has the potential to decrease postoperative pain and anesthesia requirements, accelerate patient recovery and enable access to organs that are hard to reach with conventional approaches

  • Transesophageal NOTES for mediastinal access is best accomplished using an esophageal submucosal tunneling technique

  • Two international NOTES registries have been published detailing the clinical outcomes, efficacy and safety of various transgastric and transvaginal NOTES procedures

  • Transrectal NOTES access to the peritoneum has not gained much interest, but potential advantages include preserved spatial orientation, facilitation of intuitive movements, and a large port for introduction of instruments and removal of specimens

  • NOTES plus endoscopic ultrasound for intraperitoneal endosonography is the NOTES alternative to laparoscopic ultrasound, and has shown superiority over laparoscopy alone in patients with periampullary and liver malignancies

  • When suitable instruments become available, a true comparison of NOTES with current laparoscopic approaches can be realized

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Figure 1: Transesophageal NOTES access.
Figure 2: Mediastinal NOTES.
Figure 3: Fluoroscopic view of a vertebral bone biopsy obtained by use of a transesophageal NOTES approach to the anterior thoracic spine.
Figure 4: Transgastric NOTES.

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Authors and Affiliations

  1. Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 465, Baltimore, 21287, MD

    Mouen A. Khashab & Anthony N. Kalloo

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M. A. Khashab researched data for the article and A. N. Kalloo reviewed and edited the manuscript before submission. Both authors contributed equally to the discussion of content and writing of the article.

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Correspondence to Anthony N. Kalloo.

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M. Khashab declares no competing interests.

A. N. Kalloo is a founding member, equity holder and consultant for Apollo Endosurgery.

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Khashab, M., Kalloo, A. Critical analysis of hot topics in NOTES. Nat Rev Gastroenterol Hepatol 8, 565–572 (2011). https://doi.org/10.1038/nrgastro.2011.150

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