Page 54 - WJOLS - Laparoscopic Journal

Sarat Chandra Jayasingh

Fig. 1: Different type of ports for single incision laparoscopic surgery
transcolonic route, a combined transgastric and transvaginal
approach for cholecystectomy has been performed in
Portugal. NOTES was originally described in animals by
Dr Anthoni Klloo from John Hopkin university. It was used
for appendectomy in humans in India by Rao and Reddy
and for cholecystectomy by Swanstorm in 2007. There are
different ways to perform the operation like:
1. A single access multiport device with curved instru-
ments.
2. Flexible operating endoscope with endoscopic tools.
3. Hybrid laparoscopy: Access with flexible endoscopic
instruments with simultaneous abdominal access.
4. Combined multiple natural orifice access (transgastric
+ transvaginal).
The major advantage of NOTES is the highest cosmetic
value because there is no externally visible scar after this
procedure. There is less requirement of anesthesia and
Fig. 2: Triport
immunosuppressant besides less postoperative pain, faster
Disadvantages recovery, early return to work and no abdominal wound
complications like seroma, hematoma and abscess.
a. High cost (both trocars and hand instruments)
b. Need of high expertise Similarly, NOTES is not free from its own critics. For
c. More chances of port site hernia and infection performing NOTES, highly sophisticated and expensive
d. Longer operative time endoscopic as well as hand instruments (Fig. 7), a team
e. Technically difficult of highly skilled and experienced surgeon and gynecologist
f. Mandatory port closure. are required. Another negative aspect is the unclear data
regarding its safety, clinical outcome and postoperative
NOTES complications.

Like SILS, NOTES is also a recent innovative advancement REVIEW OF SILS AND NOTES
in laparoscopic surgery in which incisionless laparoscopic
procedure is possible with an endoscope equipped with hand There exists a number of techniques for performing SILS
instruments passed through a natural orifice (oral cavity, and NOTES. These can be adopted for different intra-
urethra, vagina and anus) than through an internal incision abdominal and pelvic operations like appendectomy, 2,4-6
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7,8
in the stomach, vagina (Fig. 5), urinary bladder or colon. gastrostomy, gastrectomy, 9,10 adrenalectomy, colorectal
9
Besides the isolated transgastric (Fig. 6), transvaginal, procedures, 12-15 bariatric procedures and urological
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