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WJOLS

Comparison of Advantages and Disadvantages between SILS and NOTES
Table 1: Published reports of NOTES and SILS cholecystectomies through the years 1997–2009

Authors Approach to Number Number Number of Diagnosis Success Complication(s) Average
perinoteal cavity of skin of skin attempted rate (%) Reasons for operating
incision(s) trocar(s) cases conversion to time
standard LC (minutes)
NOTES cholecystectomy
Bessler et al 21 Transabdominal, 1 3 1 Cholelithiasis 100 None 210
transvaginal
Marescaux et al 8 Transabdominal, 1 1 1 Cholelithiasis 100 None 180
transvaginal
Zornig et al Transabdominal, 1 1 14 Cholelithiasis 100 None 62
transvaginal
3 Acute cholecystitis 100 None
3 Chronic cholecystitis 67 Hepatic injury
Forgione et al Transabdominal, 1 1 3 Cholelithiasis 100 None 136
transvaginal
SILS cholecystectomy
Tacchino et al 5 Transabdominal 1 3 10 Cholelithiasis 83 None 55 ± 7
2 Cholecystitis Subcutaneous
– hematomas (I)
– Hepatic injury (I)
Cuesta et al Transabdominal 1 2 10 Cholelithiasis 100 None 70
Rao et al Transabdominal 1 1 18 Cholelithiasis 94 Difficult dissection 40
2 Choledocholithiasis 0 Choledochoscope for
CBD exploration 2
Merchant et al 16 Transabdominal 1 1 19 Cholelithiasis 100 None 45-90
2 Acute cholecystitis 50 Difficult dissection
Zhu et al Transabdominal 2 2 22 Cholelithiasis 100 None 30-150
4 Gallbladder polyps 100 None
Romanelli et al Transabdominal 1 1 1 Cholelithiasis (history 100 None 68
of pancreatitis)
Gumbs et al Transabdominal 1 3 2 NR 100 None < 60
Palanivelu et al Transabdominal 2 2 10 Cholelithiasis 60 Hemorrhage from 148
– Cystic artery 2
– Difficult dissection 2
– Bile leak 1
Navarra et al 10 Transabdominal 1 2 30 NR 100 None 123
Piskun et al Transabdominal 1 2 7 Cholelithiasis 100 None NR
3 Acute cholecystitis 100 None

by SILS because of a common entry point. At time of NOTES, explaining the safety and complication rate of
difficulty, it is easier to convert SILS to conventional the procedure is difficult. There is no clear data available
laparoscopy without changing the patient’s position. Short till now regarding its after-effects on sexual life and
operating time, early recovery, early return to work, less infertility due to transvaginal surgery. The second negative
blood loss, and better tissue retrieval are the positive aspects aspect is the high cost of sophisticated instruments. The
of SILS. The overall patient acceptance is better compared third obstacle is the necessity of a highly skilled
to NOTES and conventional laparoscopic surgery. A few multidisciplinary team. Conventional laparoscopy can be
drawbacks of SILS include high cost of access port and conducted with the help of inexperienced assistants (interns
hand instruments, slightly extraoperative time, and highly or nurses), whereas for NOTES a whole team of
skilled and experienced surgical team to overcome the experienced surgeons and gynecologist is required. The
technical difficulties. But as the learning curve gets over, all fourth limiting factor is operation time. Conducting NOTES
the negative factors except the cost are likely to be leads to consumption of more human hour in term of
compensated. person and time. The fifth drawback is that it is not so
The attractive part of NOTES is that it is totally incision easy like SILS for conversion to traditional laparoscopy.
less, for which its acceptance in young and educated The sixth drawback is the lack of sterilization and secure
patients is relatively higher than the older people. Today, closure of internal incision in stomach or colon. A gastro-
NOTES can be used for both abdominal and mediastinal intestinal leak is the most unwanted catastrophic outcome
surgery. Elderly people with previous history of upper GI of NOTES. The seventh drawback is learning curve and
endoscopy or colonoscopy dislike NOTES because of their till now no clear data is available regarding its safety and
previous painful experience. Young females hesitate to complications. As per review of all the above literature, it
accept surgical procedure through vaginal canal. Even in is presumed that disadvantages of NOTES outweigh the
the educated mass with relatively high acceptance for no-incision benefit.

World Journal of Laparoscopic Surgery, January-April 2011;4(1):67-72 71