Natural orifice translumenal endoscopic surgery (NOTES) advantages

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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) Advantages
Proponents and researchers have recognized the potential ability of the NOTES field to revolutionize minimally invasive surgery by eliminating the body incisions. NOTES could be the next major paradigm shift in surgery, just as laparoscopy was the major paradigm shift during the 1980s and 1990s. Potential advantages of NOTES include :


 * There are faster recovery and shorter hospital stay in NOTES than laparoscopy or laparotomy procedures . Usually the patient is discharged on postoperative days 1 or 2 if the NOTES procedure has not been complicated.


 * There is less physiologic insult in NOTES procedures than laparoscopy or laparotomy procedures . There are some ongoing laboratory studies which are trying to reveal and compare the cytokine levels between NOTES procedures and laparoscopy or laparotomy procedures. One study on animals has reported that the circulating levels of cytokines (IL1, IL6, and TNF-alpha) are similar in NOTES and other approaches immediately after the surgery. However, in the later postoperative period, the levels of the cytokines was lower in NOTES procedures compared with the open or laparoscopic approaches.


 * NOTES can avoid and minimize the potential complications of wound infections. Wound infection is a common surgical complication, with a reprted incidence varies between 2% to 25%, depending on the type of surgery . Eliminating all skin incisions would eliminate the adverse impact of wound infection on the health care costs and patients' recovery.


 * NOTES Decreases the incidence of incisional hernias and postoperative adhesions . The rates of small intestinal obstruction after a laparoscopic surgery are lower than the rates after an open surgery and will perhaps be further less with NOTES procedure.


 * Moving the equipment to the patient (portable NOTES instruments) may avoid transporting the patient to the operating room, and thus making some NOTES procedures suited for an intensive care unit.


 * Anesthesia requirements in NOTES are relatively less than other types of surgery . Some NOTES procedures could be performed under conscious sedation.


 * Theoretically, NOTES causes less immunosuppression for the patient than other surgical approaches.


 * Postoperative pulmonary and diaphragmatic function are better in NOTES procedures.


 * Better cosmetic results with the potential for scarless abdominal surgery even when peritoneal intervention is required.


 * NOTES may have an advantages in specific subpopulations. It can be performed in morbidly obese patients, in whom traditional access to the peritoneal cavity can be difficult because of abdominal wall thickness, thus an easy alternative in these patients.


 * Theoretically, patients may prefer NOTES procedure over laparoscopic procedure based upon the assumption that it is scarless and less painful. Studies and surveys demonstrated that patients prefer NOTES if it is safe and effective.


 * In NOTES procedures, there is no need for single large incision through which the resected organ could be extracted. This is one of the advantages of NOTES over single-incision laparoscopic surgery (SILS).


 * Patients usually do not need post-operative narcotic medications (analgesia). This may be due to the minimal trauma for the muscle fibers, nerves and skin by this kind of surgery.