Are current NOTES techniques suffering from blind primary incision through a hollow viscus? Is it common in NOTES to achieve uncontrolled pneumoperitoneum with room air? Are NOTES procedure performed under poor endoscopic vision and with limited retraction and exposure capabilities?
IIP > read on here > http://www.medicalnewstoday.com…
…Natural orifice translumenal endoscopic surgery (NOTES) is the new “darling” of the hour. It has spawned numerous other approaches to try to reduce the incisions associated with port placement in laparoscopic surgery, most notably single incision laparoscopic surgery (SILS) which entails use of novel umbilical multiports either alone or in association with nonumbilical needlescopic ports.
The actual benefit of any of these newer approaches versus standard laparoscopy has yet to be proven as to date, only Phase I (i.e. safety) and early Phase II (i.e. efficacy) clinical experiences have been reported. While there is clinical work beginning to evolve in urology for SILS, true NOTES has yet to enter the clinical realm of urology. NOTES procedures use exclusively nonabdominal accesses alone or in combination: transgastric, transrectal, transvesical, and/or transvaginal.
The authors cite a host of challenges with NOTES as it has been applied to general surgery for the removal of the appendix or gallbladder: blind primary incision through a hollow viscus, an uncontrolled pneumoperitoneum achieved with room air, lack of support for the flexible endoscope, poor endoscopic vision as usually only a flexible endoscope is used, limited retraction and exposure capabilities, and difficulty with suturing. A pure NOTES nephrectomy has been accomplished in the laboratory via a transgastric and transvesical route, but the specimen was not removed at the end of the procedure, calling into question the translational utility of this acute laboratory exercise… Nonetheless, what we are currently witnessing is nothing more than the moving frontier of discovery, populated by creative and tireless surgeons who will bring forth ever more versatile instrumentation to overcome the aforementioned challenges.
The answer to the question “It’s new, but is it better?”
Similar to the advent of laparoscopic surgery, it may well take a decade before the answer is known.