Access and closure for NOTES

作者：S**** E^*; Miedema B W; Astudillo J A; Thaler K

来源：European Surgery-Acta Chirurgica Austriaca, 2008, 40(3): 94-102.

DOI：10.1007/s10353-008-0402-4

• NOTES
• transluminal
• minimal invasive
• endoluminal
• closure

Background: Fundamental challenges to the safe introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES) are peritoneal access and closure. We describe decontamination and sterilization protocols and explain various methods to open and close the stomach and the colon endoscopically.
Methods: A literature research was undertaken using Pubmed. Personal experiences and communications were also included in this state-of-the-art report.
Results: For both transgastric and transcolonic procedures, decontamination protocols have shown to be effective in preventing postoperative complications in porcine models. The creation of gastrotomies can be safely done using needle knife, sphincterotome and balloon dilation. Colotomies are performed with needle knifes. A multitude of devices and methods, ranging from complicated prototypes to commercially available devices have been tested for endoscopic closure.
Conclusions: Decontamination of the upper gastrointestinal entry route and creation of gastrotomies for NOTES seem to be safe in porcine models and humans. Creation and closure of colotomies were successfully performed in animal models. Further work is needed in the development of endoscopic closure devices.

• 出版日期2008