Natural orifice translumenal endoscopic surgery (NOTES) current technological developments

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Editor-In-Chief: Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org] Phone:617-849-2629

Synonyms and keywords: Natural orifice translumenal endoscopic surgery, Single incision laparoscopic surgery, Minimally invasive surgery, Transanal endoscopic microsurgery, Natural orifice surgery consortium for assessment and research, Society of american gastrointestinal and endoscopic surgeons.

Natural Orifice Translumenal Endoscopic Surgery (NOTES) Current Technological Developments
The development of NOTES instruments is emerging to make these procedures feasible and safe. These instruments include platforms and many other tools, such as suturing devices and anastomotic (nonsuturing) devices. The new platform permits the performance of a large intraabdominal procedure in a faster and more accurate fashion.

University of California San Diego and Novare Endosurgical developed a new grasper that can be used in NOTES procedures through the same port of the endoscopes. The grasper is long (around 75 cm) and can be articulated for flexible retraction. In the same time, it is rigid enough to provide a stronger retraction than the endoscopic grasper.

The preferred way to gain access to the peritoneal cavity via a hollow viscus (lumen) is a very small incision (minimal) followed by a balloon expansion and dilatation. A tiny incision can be made using a sphincterotome or a needle knife. Improved energy sources devices should be further developed for dissection and hemostasis in NOTES procedures. Tissue approximation devices and secured incision closure devices should be further developed as well.

Although a direct insertion of an endoscope and the NOTES instruments is possible, Overtube is usually used to permit multiple entries to the field the procedure and to perform complex maneuvers.

Currently, there are many research studies by engineers which focuse on computer assisted imaging systems that provide additional 3-D information of the intervention site. Virtual off-axis view assists surgeons with a better visual depth perception during the intervention. Video images can be rectified using the impact of gravity on a 3-axis accelerometer integrated in the tip of the endoscope.