Natural orifice transluminal endoscopic surgery (NOTES)
- Pankaj J Pasricha, MD
Pankaj J Pasricha, MD
- Professor of Medicine and Neuroscience
- Johns Hopkins University School of Medicine
- Director, Johns Hopkins Center for Neurogastroenterology
- Homero Rivas, MD, MBA, FACS
Homero Rivas, MD, MBA, FACS
- Assistant Professor
- Section, Minimally Invasive Surgery
- Director of Innovative Surgery
- Stanford School of Medicine
- Section Editor
- Douglas A Howell, MD, FASGE, FACG
Douglas A Howell, MD, FASGE, FACG
- Section Editor — EUS/ERCP
- Assistant Clinical Professor of Medicine, Tufts Medical School Director,
- Pancreaticobiliary Center Director, Advanced Interventional Endoscopy Fellowship, Maine Medical Center
Natural orifice transluminal endoscopic surgery (NOTES) is an emerging field within gastrointestinal surgery and interventional gastroenterology in which the surgeon accesses the peritoneal cavity via a hollow viscus and performs diagnostic and therapeutic procedures. NOTES is evolving rapidly, presenting seemingly limitless possibilities for innovation, technique, and device development.
EXPERIMENTAL EVOLUTION AND DEVELOPMENT
The concept of flexible transluminal endoscopy, a term used before NOTES was coined, was first developed by a multicenter team of investigators (the Apollo Group) in the late 1990s . The publication of the initial animal studies generated a wave of enthusiasm, and many centers began experiments of their own, using the NOTES approach for a variety of operations . These have ranged from diagnostic explorations of the peritoneal cavity to complex organ resections including pancreatectomy, splenectomy, and nephrectomy [3-5].
The initial approach was transgastric, but more recently NOTES has been performed through several other orifices, resulting in transcolonic, transvaginal, and transurethral/transcystic approaches. The approach has also been extended from the peritoneum to other compartments in the body, such as transesophageal approaches to the mediastinum and heart, transgastric intrauterine interventions in pregnant animals, and novel approaches to the vertebral column [6-9].
Given this flurry of activity and mounting enthusiasm, in 2005 the American Society of Gastrointestinal Endoscopy and the Society of Gastrointestinal Endoscopic Surgeons came together in a consortium (the Natural Orifice Surgery Consortium for Assessment and Research) to provide consensus and guidelines on how best to bring this procedure to the clinical mainstream. In the last few years, an increasing number of NOTES procedures in humans have been performed. However, technological limitations of the current flexible platforms have been a major challenge, limiting the adoption of this approach (to date) to a few major medical centers. Nevertheless, while it is still too early to predict its ultimate role and value, it is clear that NOTES has dramatically altered our perceptions of how to approach gastrointestinal surgery.
A strong argument can be made that NOTES has been instrumental in the resurgence of lesser invasive surgical techniques such as single-incision laparoscopic surgery, which for some may represent a bridge to NOTES [10-14]. Furthermore, developmental efforts in NOTES have resulted in numerous advanced surgical and endoscopic technologies that are now being applied in conventional laparoscopic and endoscopic techniques.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Pasricha PJ. NOTES: a gastroenterologist's perspective. Gastrointest Endosc Clin N Am 2007; 17:611.
- Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004; 60:114.
- Ryou M, Fong DG, Pai RD, et al. Dual-port distal pancreatectomy using a prototype endoscope and endoscopic stapler: a natural orifice transluminal endoscopic surgery (NOTES) survival study in a porcine model. Endoscopy 2007; 39:881.
- Isariyawongse JP, McGee MF, Rosen MJ, et al. Pure natural orifice transluminal endoscopic surgery (NOTES) nephrectomy using standard laparoscopic instruments in the porcine model. J Endourol 2008; 22:1087.
- Kantsevoy SV, Hu B, Jagannath SB, et al. Transgastric endoscopic splenectomy: is it possible? Surg Endosc 2006; 20:522.
- Sumiyama K, Gostout CJ, Rajan E, et al. Pilot study of transesophageal endoscopic epicardial coagulation by submucosal endoscopy with the mucosal flap safety valve technique (with videos). Gastrointest Endosc 2008; 67:497.
- Fritscher-Ravens A, Patel K, Ghanbari A, et al. Natural orifice transluminal endoscopic surgery (NOTES) in the mediastinum: long-term survival animal experiments in transesophageal access, including minor surgical procedures. Endoscopy 2007; 39:870.
- Giday SA, Buscaglia JM, Althaus J, et al. Successful diagnostic and therapeutic intrauterine fetal interventions by NOTES (abstract). Gastrointest Endosc 2008; 67:AB104.
- Magno P, Mas MA, Rivera Y, et al. NOTES Is Successful for vertebral spinal interventions with significant advantages for anterior spinal procedures (abstract). Gastrointest Endosc 2008; 67:AB114.
- Gill IS, Advincula AP, Aron M, et al. Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 2010; 24:762.
- Curcillo PG 2nd, Wu AS, Podolsky ER, et al. Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 2010; 24:1854.
- Rivas H, Varela E, Scott D. Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients. Surg Endosc 2010; 24:1403.
- Ahmed K, Wang TT, Patel VM, et al. The role of single-incision laparaoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc 2010; Jul 10:Epub ahead of print.
- Antoniou SA, Pointner R, Granderath FA. Single-incision laparaoscopic cholecystectomy: a systematic review. Surg Endosc 2010; Jul 7:Epub ahead of print.
- Cuschieri A. Minimal access surgery: the birth of a new era. J R Coll Surg Edinb 1990; 35:345.
- Lacy AM, Delgado S, Rojas OA, et al. MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 2008; 22:1717.
- Zornig C, Mofid H, Siemssen L, et al. Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up. Endoscopy 2009; 41:391.
- Lehmann KS, Ritz JP, Wibmer A, et al. The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 2010; 252:263.
- Chukwumah C, Zorron R, Marks JM, Ponsky JL. Current status of natural orifice translumenal endoscopic surgery (NOTES). Curr Probl Surg 2010; 47:630.
- Swain P. A justification for NOTES--natural orifice translumenal endosurgery. Gastrointest Endosc 2007; 65:514.
- Varadarajulu S, Tamhane A, Drelichman ER. Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy. Gastrointest Endosc 2008; 67:854.
- Strickland AD, Norwood MG, Behnia-Willison F, et al. Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women's views on a new technique. Surg Endosc 2010; 24:2424.
- Mummadi RR, Pasricha PJ. The eagle or the snake: platforms for NOTES and radical endoscopic therapy. Gastrointest Endosc Clin N Am 2008; 18:279.
- Pasricha PJ. The future of therapeutic endoscopy. Clin Gastroenterol Hepatol 2004; 2:286.
- McGee MF, Marks JM, Onders RP, et al. Infectious implications in the porcine model of natural orifice transluminal endoscopic surgery (NOTES) with PEG-tube closure: a quantitative bacteriologic study. Gastrointest Endosc 2008; 68:310.
- McGee MF, Schomisch SJ, Marks JM, et al. Late phase TNF-alpha depression in natural orifice translumenal endoscopic surgery (NOTES) peritoneoscopy. Surgery 2008; 143:318.
- Bingener J, Michalek J, Van Sickle K, Schwesinger W. Randomized blinded trial shows relative thrombocytopenia in natural orifice translumenal endoscopic surgery compared with standard laparoscopy in a porcine survival model. Surg Endosc 2008; 22:2067.
- Bingener J, Michalek J, Winston J, et al. Randomized blinded trial comparing the cardiopulmonary effects of NOTES with standard laparoscopy in a porcine survival model. Surg Endosc 2008; 22:1430.
- Guo J, Pasricha NP, Shenoy MM, et al. Transgastric versus laparoendoscopic single-site peritoneoscopy in a rat model: effects on motility, inflammation, and nociception. Surg Endosc 2012; 26:747.
- McGee MF, Rosen MJ, Marks J, et al. A reliable method for monitoring intraabdominal pressure during natural orifice translumenal endoscopic surgery. Surg Endosc 2007; 21:672.
- Maiss J, Zopf Y, Hahn EG. Entrance barriers and integration obstacles of NOTES. Minim Invasive Ther Allied Technol 2010; 19:287.
- Steinemann DC, Müller PC, Probst P, et al. Meta-analysis of hybrid natural-orifice transluminal endoscopic surgery versus laparoscopic surgery. Br J Surg 2017; 104:977.
- Wood SG, Panait L, Duffy AJ, et al. Complications of transvaginal natural orifice transluminal endoscopic surgery: a series of 102 patients. Ann Surg 2014; 259:744.
- Nikfarjam M, McGee MF, Trunzo JA, et al. Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and gastrotomy site selection by using a hybrid technique. Gastrointest Endosc 2010; 72:279.
- Marks JM, Ponsky JL, Pearl JP, McGee MF. PEG "Rescue": a practical NOTES technique. Surg Endosc 2007; 21:816.
- Zorrón R, Soldan M, Filgueiras M, et al. NOTES: transvaginal for cancer diagnostic staging: preliminary clinical application. Surg Innov 2008; 15:161.
- Pasricha PJ, Hawari R, Ahmed I, et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 2007; 39:761.
- von Renteln D, Inoue H, Minami H, et al. Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 2012; 107:411.
- Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42:265.
- Verlaan T, Rohof WO, Bredenoord AJ, et al. Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. Gastrointest Endosc 2013; 78:39.
- Von Renteln D, Fuchs KH, Fockens P, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology 2013; 145:309.
- Bhayani NH, Kurian AA, Dunst CM, et al. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg 2014; 259:1098.
- Khashab MA, Messallam AA, Onimaru M, et al. International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc 2015; 81:1170.
- Burghardt J, Buess G. Transanal endoscopic microsurgery (TEM): a new technique and development during a time period of 20 years. Surg Technol Int 2005; 14:131.
- Jay Pasricha P, Krummel TM. NOTES and other emerging trends in gastrointestinal endoscopy and surgery: the change that we need and the change that is real. Am J Gastroenterol 2009; 104:2384.
- EXPERIMENTAL EVOLUTION AND DEVELOPMENT
- PREMISE AND PROMISE OF NOTES
- TECHNICAL CONSIDERATIONS
- Bacterial contamination, peritonitis, and abscess formation
- Effects on the immune system and other physiological effects
- Inability to deal with major complications
- Training and credentialing
- Economic limitations
- HUMAN EXPERIENCE
- Transvaginal NOTES
- Transgastric NOTES
- Miscellaneous approaches
- IMPLICATIONS BEYOND THE PROCEDURE ITSELF
- SUMMARY AND RECOMMENDATIONS