经自然腔道内镜手术的进展

经自然腔道内镜手术是一种新兴的微创外科技术,它通过在自然腔道（如胃、阴道、直肠、膀胱）人为造口,然后置入软式内镜经造口进入腹腔完成手术.因其可以避免腹部切口从而实现了体表无瘢痕的目的 .尽管经自然腔道内镜手术目前还处于早期阶段,但随着技术的发展,必将开创微创外科的新纪元.     

经自然腔道内镜手术的研究进展

近年来,经自然腔道内镜手术已在全球取得了长足的发展.目前,已有大量经自然腔道内镜手术应用于实验动物及人体,如经阴道胆囊切除术、经阴道阑尾切除术、经胃阑尾切除术、经膀胱腹腔镜检术等.本文就目前经自然腔道内镜手术的研究进展及面临的挑战作一综述.     

经自然腔道内镜手术的研究进展

经自然腔道内镜手术( natural orifice translumenal endoscopic surgery,NOTES)是国内外研究的热点,目前已从动物实验进入初步临床应用阶段,然而NOTES进入临床所面临的问题仍然很多.现对其研究进展进行总结回顾.     

经自然腔道内镜手术的基础研究现状与进展

经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)是国内外研究的热点,目前已从动物实验进入初步临床应用阶段。在这数年的研究与临床实践中,NOTES所面临的问题越来越清晰,其与常规开腹及经典腹腔镜手术的对比也已有了初步结论,现对其进行总结回顾。     

经自然腔道内镜手术在腹部外科手术中的发展与展望

瘢痕一直被认为是手术后的必然产物。为了在手术中达到充分的暴露,大手术常会产生大瘢痕。但自20世纪80年代开始,随着腹腔镜微创外科技术的不断发展,人们意识到大手术也同样可以只留下小瘢痕,而且具有病人痛苦小、术后恢复快和美观等优点。人们逐渐改变了对以往手术入路的认识,"微创"才是未来外科发展的方向。近年来,一种挑战传统外科观念的全新技术吸引了腹腔镜和内镜医师们的极大兴趣,成为研究和争议的焦点,这就是被称为"无瘢痕手术"的经自然腔道内镜手术(natural orifice translumenal     

经自然腔道内镜手术研究进展及其在泌尿外壳领域的应用

腹腔镜手术技术的引人及发展对于患者的治疗起到了非常重要的作用.经自然腔道内镜手术（natural orifice transluminal endoscopic surgery,NOTES）是一种新出现的、结合内镜与腹腔镜技术经由自然腔道（如：口、肛门、阴道、尿道等）对腹腔内病变进行诊断和治疗的手术方法.因其具有无需腹部手术切口、消除了切口相关并发症、减少腹腔内粘连、术后疼痛轻、恢复快等潜在优势而得以迅速发展.本文将对NOTES在泌尿科的应用及发展史作一综述.     

经自然腔道内镜外科手术

21世纪风起云涌的微创外科理念和层出不穷的微创治疗手段改变了传统外科的面貌,昭示着一个微创外科时代的到来。纵览历史长河,微创理念早已有之．历来的外科医生都在思考如何使外科手术减少创伤而有更好的疗效。腹腔镜胆囊切除术已走过10余年的历程．现在几乎所有疾病的治疗都有可能用腹腔镜技术完成。     

经阴道路径自然腔道内镜外科的临床应用进展

目的综述经阴道路径自然腔道内镜外科的临床应用进展。方法经自然腔道内镜手术是治疗肾脏疾病的新型外科手术方式,理论上可以体表无创达到腹壁无疤痕,减少患者术后痛苦等并发症,可使患者术后尽早恢复。检索收集国内外关于经阴道路径自然腔道内镜外科的相关文献进行综述。结果 PubMed检索结果获得文献68篇,CNKI检索获得文献40篇,文献发表时间主要集中在2007年以后,研究主要关注于经阴道路径自然腔道内镜手术在泌尿外科临床运用中的结果,多数文献的结论有利经自然腔道内镜手术。结论目前经自然腔道内镜手术的理论优势已经得到动物试验和体外模型试验的证实,随着设备及技术的逐步完善,观念的更新及手术操作等问题的解决,经自然腔道内镜手术将创造微创外科的全新时代。     

经自然腔道内镜技术在泌尿外科的应用

经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)代表着即将到来的微创治疗新时代,是继腹腔镜手术后又一次外科领域的革新,与传统开放手术不同,NOTES减少了腹壁切口和手术并发症.随着腹腔镜技术和理念的普及、内镜治疗器械和技术的进步,NOTES...     

经自然腔道内镜手术：临床应用与未来展望

目的可弯曲内镜经自然腔道进入腹腔进行手术,标志着微创治疗在追求无瘢痕手术目标的重大进步。在众多研究机构数年的共同努力之下,自然腔道手术逐渐成为一种可靠的治疗方法,既能采用完全内镜方式,又可结合腹壁微创辅助支持。充满希望的手术结果,及能左右患者决定并可引起极大关注的总是寻找疗效确切、微创、恢复迅速的治疗手段。上述因素不断推动相应专业的发展,而各种技术壁垒的突破将使自然腔道-无瘢痕手术更为简便,并能重复进行,甚至用于治疗复杂病例。自然腔道手术具有结束外科手术与瘢痕疼痛如影随形历史的潜能,并因高度重视患者身心健全,成为一种极具吸引力的手术选择。     

结直肠肿瘤类-NOTES手术实践与关键技术

结直肠肿瘤类-NOTES手术具有创伤小、恢复快等优势。与传统腹腔镜手术比较,该技术的最大特点在于经自然腔道取标本以及独特的消化道重建方式与技巧。随着结直肠肿瘤类-NOTES手术的不断推广,类-NOTES手术的相关技术要点也在逐步积累完善,其术后疗效也在获得证实。当然,类-NOTES手术想要更好的普及和发展,建立起一系列完整详细的技术规范体系是至关重要的,这也需要从解剖学、手术技术、手术方式等多个方面来综合考虑。本文就结直肠肿瘤类-NOTES手术的实践经验和技术要点谈一下个人的心得体会。     

经自然腔道取标本在腹腔镜直肠癌根治术中的应用进展

直肠癌根治手术从最初提出全直肠系膜切除(TME)理念到腹腔镜广泛应用于直肠癌根治,经过30多年的迅猛发展,腹腔镜直肠癌TME手术现已成为直肠癌患者的首选术式,但是该手术用于取出肿瘤标本的腹壁辅助切口与当今微创手术理念相悖,避免腹壁切口成为胃肠外科医生和直肠癌患者共同诉求。经自然腔道取标本手术(NOSES)在全腔镜下完成直肠癌根治及消化道的重建,标本经自然腔道(直肠或者阴道)取出,无腹壁辅助切口,更符合微创实际,操作更简便。研究NOSES腹腔镜直肠癌根治术的手术进展,旨在为该术式提供一定的参考。     

Evaluation for transvaginal and transgastric NOTES cholecystectomy in human and animal natural orifice translumenal endoscopic surgery

Background/purpose  Natural orifice translumenal endoscopic surgery (NOTES) is a novel concept using an endoscope via a translumenal access for abdominal surgery. This study was designed to evaluate the feasibility and technical aspects of NOTES cholecystectomy from our experience on humans and animals. Methods  NOTES cholecystectomies were performed in 12 animal experiments, including 8 pigs (6 by transgastric and 2 by transvaginal accesses) and 4 dogs (4 transvaginal accesses), and a human female cadaver. Results  The entire gallbladder could be removed under direct vision in all experiments. The average time was 60 min by transgastric and 40 min by transvaginal in animals. It was 87 min for human transvaginal cholecystectomy. In all animal and human procedures, there was no major complication concerning the operation. Discussion  The transvaginal route may be the easiest route for abdominal NOTES. Percutaneous endoscopic gastrostomy (PEG) allowed the safe performance of a controlled gastric perforation and shortened the time. The hybrid method allowed performance of a safe procedure and shortened the time. Conclusions  Transvaginal and transgastric NOTES cholecystectomy is technically feasible and safe in both humans and animals. New instrumentation needs to be developed to perform a pure NOTES cholecystectomy without transabdominal assistance.     

Natural orifice translumenal endoscopic surgery (NOTES) for innovation in hepatobiliary and pancreatic surgery: preface

Introduction  Natural orifice translumenal endoscopic surgery (NOTES) has captured the interest of interventional endoscopists and may represent the next stage of evolution of minimally invasive surgery. It provides the potential for performance of incisionless operations. It is gaining momentum both in the animal laboratory and in human case reports. Developments in the field of NOTES have led to the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) in 2006. Materials and methods  In this special issue, the current trends in NOTES in the field of hepatobiliary and pancreatic surgery are featured, including NOTES cholecystectomy, hepatectomy splenectomy, pancreatic necrosectomy, and the future of NOTES. In this issue, we discuss the potential benefits of these procedures in hepatobiliary and pancreatic surgery. Conclusion  We have just started the evaluation process for this new technology. The concept of NOTES is becoming established and is enormously advantageous for the patient. Both the surgeon and gastroenterologist should contribute to developing NOTES in making use of their specialties.     

Recent advances of natural orifice transluminal endoscopic surgery in urological surgery

Natural orifice transluminal endoscopic surgery designates a surgical procedure that utilizes one or more patent natural orifices of the body with the intention to puncture a hollow viscera in order to enter the abdominal cavity. First carried out at the beginning of the 2000s in experimental models, it can be considered the natural evolution of laparoscopy towards the ideal of scarless surgery, as the avoidance of a large abdominal scar is associated with better cosmetic results and better recovery. However, the technology currently available does not allow the performance of complete pure natural orifice transluminal endoscopic surgery procedures. The surgical tools used are not specially designed for this approach, so difficulties in retracting organs, bleeding control and clashing of instruments are the main obstacle surgeons face. For this reason, the current available technique is the so‐called hybrid approach, where a natural orifice approach is combined with some abdominal trocars, using the natural orifice as the exit door for the specimen removal. As not many comparative studies have been published evaluating the advantages of natural orifice transluminal endoscopic surgery in front of traditional laparoscopic surgery, a review of the history of natural orifice transluminal endoscopic surgery, and an assessment of the available evidence of this technique regarding renal and urological pelvic surgery are performed in this article.     

Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice

Background  Natural orifice translumenal endoscopic surgery (NOTES), with its focus on eliminating incision-related complications, promises to revolutionize the way surgery is performed. This study aimed to summarize the clinical applications of NOTES for humans, outline the techniques used, and discuss the complications and limitations of current techniques. Methods  A literature search was performed using PubMed and Medline search tools to review the extent and outcomes of human procedures undertaken using the NOTES technique in its pure form or as a hybrid procedure reported until July 2008. The end points were the types of operation performed, the approach and technique used for each operation, and the procedure-related complications and technical limitations. Results  This review considered 16 publications reporting on 49 human subjects. All the studies except three used hybrid NOTES procedures, with varying amounts of transabdominal assistance. Three transvaginal cholecystectomies, one transvaginal appendectomy, and eight transgastric appendectomies have been performed using a pure NOTES technique. To date, 15 NOTES transvaginal cholecystectomies and 10 NOTES appendectomies (8 transgastric and 2 transvaginal) are reported. Other procedures including peritoneoscopy and sigmoid colectomy are described. Three cases of minor morbidity are reported and no mortality. Conclusions  Although initial human results seem encouraging, it is important that this research be conducted in a way that minimizes bad publicity and describes both favorable and adverse outcomes. Robust trials must be conducted at established centers with appropriate experience and institutional board ethical review to allow safe introduction of this novel technique, with adequate and expedient reporting of serious adverse events. The limitations of the current tools and methods are discussed, and suggestions are made for further improvements in the technology to facilitate NOTES operations.     

经自然腔道内镜技术和单孔腹腔镜技术在结直肠外科手术中的应用

经自然腔道内镜手术（NOTES）和单孔腹腔镜手术（LESS）是当今国际微创外科领域的研究与临床应用热点。NOTES技术尚待进一步的发展．而LESS技术是现阶段最可行的体表“无疤痕”技术。是NOTES技术的过渡阶段。虽然腹腔镜辅助的NOTES结直肠手术和完全的NOTES结直肠手术已经见诸报道．但是该手术目前仍然主要处于动物试验阶段。LESS技术在结直肠手术中的应用已经较为广泛．其可行性已经为较多的文献资料证实．而其是否符合肿瘤根治原则尚需进一步的研究确定。     

Natural orifice translumenal surgery: Flexible platform review

Natural orifice translumenal surgery (NOTES) has garnished significant attention from surgeons and gastroenterologists, due to the fusion of flexible endoscopy and operative technique. Preliminary efforts suggest that NOTES holds potential for a less invasive approach with certain surgical conditions. Many of the hurdles encountered during the shift from open to laparoscopic surgery are now being revisited in the development of NOTES. Physician directed efforts, coupled with industry support, have brought about several NOTES specific devices and platforms to help address limitations with current instrumentation. This review addresses current flexible platforms and their attributes, advantages, disadvantages and limitations.