The NOTES technique

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is “an experimental surgical technique whereby "scarless" abdominal operations can be performed with an endoscope passed through a natural orifice (mouth, urethra, anus, etc.) then through an internal incision in the stomach, vagina, bladder or colon, thus avoiding any external incisions or scars.” as wiki says. In fact this is a new and promising technology that extensively combines technology and medicine. The name was invented at Hopkins, when first used on animals by Dr. Kalloo., as a developed version of single port laparoscopy (also called single incision laparoscopic surgery - SILS). The first human operation was in June 2007, a transgastric cholecystectomy. (An excellent review on NOTES can be found here.)
NOTES provides numerous patient benefits, such as reduced pain, faster recovery, better cosmetic outcome (making it popular e.g. among models) and lower risk of infection. One of the great advantages is that theoretically no sterile environment is required, only sterile equipment. The single port entry means serious limitations in spatial motion beyond making laparoscopy manageable in obese patients, children or burnt patients. Hyper-redundant endoscopes must be used to achieve in-body navigation, and many surgeons are needed to manipulate these devices. (More videos are here.) Research labs all around the world are trying to provide an automated tool for NOTES. One example from Singapore uses a bigger endoscopic tube to introduce a two-armed manipulator to the surgical field. Similar devices have been developed at UGSI as well.
There are many other ways to promote this technology, such as combining it with real-time 3D visualization and augmented reality applications, such as the MUSTOF endoscope (Multi-Sensor-Time-Of-Flight) from Friedrich-Alexander-University, Germany, presented recently at a lab seminar.
NOTES today is still looking for the killer application that would best benefit from the development and justify the higher costs of the procedures. The main goals of the Natural Orifice Surgery Consortion for Assessment and Research (NOSCAR) working group are to solve the question of stability and navigation in the next five years while providing more advanced tools with the capability of triangulation, and additional features such as stapling and closing.


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