Natural orifice translumenal endoscopic surgery

NOTES is the acronym for Natural Orifice Transluminal Endoscopic Surgery ( also Natural orifice translumenal endoscopic surgery, in German as: endoscopic surgery through natural orifices ). It is a surgically - endoscopic procedure, which is an evolution of laparoscopic surgery and gastroenterological endoscopy.

At laparoscopy instruments are inserted through small incisions in the body, larger openings are avoided ( Minimally Invasive Surgery ). The NOTES changed the technology meaning that the instruments are inserted through the mouth, anus, vagina, colon or urethra. Through a small incision in the esophagus, stomach, colon, vagina or bladder, the surgeon can reach the actual area of ​​operations, such as the gallbladder. After surgery, the incision is closed with clips, tissue anchors, staples or stitching.

The technique is essentially still experimental, but is already carried out on humans. Currently only come handy hybrid methods are used where access via the vagina and another access over the belly button ( transumbilical ) is required. More unsatisfactory solved problems are to have a stable abutment for the preparation of the operation area of re- occlusion of the portal of entry, the often sterile access path as well as the excessive flexibility of the endoscope with the result. The potential advantages of this method are listed below: The stomach has less pain receptors, so that with less anesthetic ( anesthetic ) can be used, and the recovery time is shorter. The stomach acid can make existing bacteria harmless policy. With conventional laparoscopy inaccessible organs or body regions, such as the pancreas and the mediastinum can be better achieved under certain circumstances with this method. In addition, there are no visible scars on the body surface. For these reasons, the method currently in South America is currently very popular. In Germany until April 2013 a total of 2784 operations were registered, of which 2696 operations in the transvaginal hybrid technology, 35 transgastrically and 21 with another access ( NOTES tab of DGAV: Update 2013 K.Lehmann, DGAV annual congress ). Besides gall bladder removal and appendectomy, colon surgery and gastric resection were mainly in the obesity surgery.

However, it should be noted that so far only very few interventions could be performed without skin incisions and that the transvaginal hybrid technology only reduces the number of abdominal wall incisions. Also, there are naturally no long-term results or reports of adverse effects.