Natural Orifice Transluminal Endoscopic Surgery

Twenty years have passed since the first laparoscopic cholecystectomy was conducted by P. Moruet in 1987. Since then, the success of laparoscopy has been undeniable. Almost all surgical procedures can be carried out using laparoscopic techniques. The majority of those procedures that can be performed laparoscopically do so regularly. Laparoscopic gallbladder and bile ducts surgery, exploratory laparoscopy, appendectomy, anti-reflux procedures, and adrenal surgery are examples of today’s standard laparoscopic procedures. The number of more advanced laparoscopic procedures is constantly increasing. Intestinal surgery, oesophagus resections, parenchymal organ surgery, inguinal hernias, and in particular, postoperative hernia repairs are carried out in most surgical departments; in many of those, they care carried out regularly. The philosophy of surgical management is changing along with the development of new technology. Surgeons constantly aspire to reduce the invasiveness of their procedures. One of the promising methods of achieving this goal seems to be “incisionless” natural orifice transluminal endoscopic surgery (NOTES). Although many terms, such as “incisionless”, “transluminal”, “natural orifice transluminal endoscopic surgery” or “NOTES”, describe this kind of procedure in the literature, there is not yet an official Polish terminology. This method may become a promising alternative to classic or laparoscopic surgeries, because achieving minor postoperative pain, shorter postoperative management, and perfect cosmetic effect is possible with its use (1). The term most often used in literature, approved by NOSCAR (Natural Orifice Surgery Consortium for Assessment and Research), is “NOTES” (Natural Orifice Transluminal Endoscopic Surgery). In 2005, SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) stated that “we are convinced it is fair to our colleagues to say that an era of laparoscopic revolution has ended. The era of natural orifice transluminal endoscopic surgery has started” (2). The basic premise of NOTES rests on inserting a flexible endoscope through natural orifices of the body, such as the mouth, anus, vagina, incising stomach wall, rectum, or vaginal fornix, and then guiding the endoscope to peritoneal cavity where the surgical procedure is conducted. Many NOTES procedures, such as peritoneoscopy, appendectomy, cholecystectomy, spleen resection, resection of the pancreatic tail , gastroenterostomy, bariatric gastric-by-pass and sleeve resection, cholecystogastrostomy, tubal ligation, salpingo-ovariectomy, debridement in hemorrhagic and necrotizing pancreatitis, and guided biopsy procedures, have been studied in animal models (1, 3, 4). During the EAES congress in Berlin in 2006, Rao presented the first series of seven human cases of appendectomy conducted using NOTES.