Abstract
The potential benefits of NOTES (Natural Orifice Transluminal Endoscopic Surgery) technique are today being evaluated by many experimental and clinical studies. Most of the NOTES procedures in humans are performed as a hybrid approach with laparoscopic assistance (cholecystectomy, appendectomy).
Transvaginal ortransgastric accesses are used most often, but a safe closure of the latter has not yet been discovered. Considering the published low postoperative infections rate, perioperative intraabdominal contamination does not appear to be such an important issue.
There was no higher incidence of perioperative complications in transvaginal procedures. On the other hand, the risk of esophageal injury in transgastric cholecystectomy is relatively high.
Many different closure techniques were invented and evaluated in experimental trials, e.g. clips, sewing or stapling systems, loop occlusion techniques, as well as new prototypes of multitasking platforms, which were confirmed as superior to conventional endoscopes. The authors performed several experimental studies on NOTES in the years 2009-2011.
In comparison with transgastric ovarectomy and hybrid transrectal cholecystectomy with the laparoscopic approach, there was no significant difference in mortality, the postoperative complications rate or the systemic inflammatory response. The novel loop-and-clip technique ("King's closure") was invented and proved as a safe and feasible method in gastrotomy and colotomy closure.
In conclusion, the recent results of NOTES trials have not confirmed the benefit of this technique in comparison with laparoscopy. However, NOTES has led to a remarkable development of endoscopic equipment and accessories.