Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice |
| |
Authors: | Mikael H Sodergren James Clark Thanos Athanasiou Julian Teare Guang-Zhong Yang Ara Darzi |
| |
Institution: | (1) Department of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, 10th Floor QEQM, St. Mary’s Hospital, South Wharf Road, London, W2 1NY, USA;(2) Institute of Biomedical Engineering, Imperial College London, London, UK |
| |
Abstract: | 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. |
| |
Keywords: | Natural orifice translumenal endoscopic surgery Human studies Systematic review |
本文献已被 SpringerLink 等数据库收录! |
|