Natural orifice translumenal endoscopic surgery (NOTES) future directions

For the WikiPatient page for this topic, click here

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) Future Directions
Operating on intensive care unit patients may be the future progression in NOTES procedures and may offer many benefits. Transgastric placement of diaphragm pacing for weaning the ICU patients from the ventilator may lead to several potential benefits over other methods of pacing. This procedure could be performed at the bedside.

NOTES may become the preferred method to operate on selected patients (specific population). Morbidly obese patients and those with severe intra abdominal adhesions are good candidates for NOTES.

More studies should be conducted to find clear clariﬁcations for the following issues :
 * The best and the safest way to traverse the wall of the lumen in order to get access to the organ.
 * Controlling the complications of every single NOTES procedure.
 * Improving spatial orientation to perform the procedure.
 * The best closure for the translumenal incisional site. Methods of reliable full thickness, watertight closure for the puncture sites in different organs should be developed.
 * Specific ways for organ extraction through the natural orifices.
 * Methods to prevent infections during NOTES procedures.
 * Anesthesia level requirement for every NOTES procedure.
 * Optimal instrumentation and devices for every NOTES procedure.