Page 24 - World Journal of Laparoscopic Surgery
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S Abbas, R Rizvi

               The infectious implications of transvisceral surgery may  REFERENCES
            not be as critical as originally presumed. Certainly, bacteria
                                                                 1. Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric
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            is efficient at clearing the microbes. After all, the bariatric  interventions in the peritoneal cavity. Gastrointest Endosc
            surgeon is not overly worried about the gastrotomy      2004;60(1):114-17.
            contaminating the peritoneal cavity during construction of  2. McGee MF, Rosen MJ, Marks J, et al. A primer on natural
                                                                    orifice transluminal endoscopic surgery: Building a new paradigm.
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            gastrotomy is not harmful, but peritoneal soilage from a  3. McGee M, Marks J, Onders R, et al. Infectious complications
            leaking closure may be devastating. Therefore, a substantial  of natural orifice translumenal endoscopic surgery with
            amount of effort should be devoted to assuring a reliable  percutaneous endoscopic gastrostomy tube closure:
                                                                    A quantitative bacteriologic study in the porcine model. Surg
            method of viscerotomy closure.
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               Other studies have also shown optimism regarding
                                                                 4. Rattner D, Kalloo A. ASGE/SAGES Working Group on Natural
            NOTES, as evidence is accumulating that the immune impact  Orifice Translumenal Endoscopic Surgery. Surg Endosc 2006;20
            of NOTES is equivalent to laparoscopy. Some groups are  (2):329-33.
                                                                 5. Jagannath SB, Kantsevoy SV, Vaughn CA, et al. Peroral
            developing ingenious methods of intra-abdominal access,
                                                                    transgastric endoscopic ligation of fallopian tubes with long-
            retraction and dissection. Novel methods of transgastric
                                                                    term survival in a porcine model. Gastrointest Endosc
            access might simplify the issue of reliable closure. In  2005;61(3):449-53.
            aggregate, these data might be a further evidence that there  6. Kantsevoy SV, Jagannath SB, Niiyama H, et al. Endoscopic
            is a role for NOTES in gastrointestinal surgery.        gastrojejunostomy with survival in a porcine model. Gastrointest
                                                                    Endosc 2005;62(2):287-92.
                                                                 7. Kantsevoy SV, Hu B, Jagannath SB, et al. Transgastric
            CONCLUSION                                              endoscopic splenectomy: Is it possible? Surg Endosc
                                                                    2006;20(3):522-25.
            At present, this is generally true that routine NOTES chole-  8. Sumiyama K, Gostout CJ, Rajan E, et al. Pilot study of the
            cystectomies or appendectomies (i.e. those not under the  porcine uterine horn as an in vivo appendicitis model for
                                                                    development of endoscopic transgastric appendectomy.
            aegis of an approved clinical trial) should probably not be
                                                                    Gastrointest Endosc 2006;64(5):808-12.
            performed until laboratory and technical advances
                                                                 9. Pai RD, Fong DG, Bundga ME, et al. Transcolonic endoscopic
            materialize. Contrarily, there are likely a limited number of  cholecystectomy: A NOTES survival study in a porcine model
            applications that are well-suited to the current application  (with video). Gastrointest Endosc 2006;64(3):428-34.
                                                                10.  Wagh MS, Merrifield BF, Thompson CC. Survival studies after
            of NOTES, e.g. PEG rescue is a simple procedure that
                                                                    endoscopic transgastric oophorectomy and tubectomy in a
            relies on available equipment and could have a role in patients
                                                                    porcine model. Gastrointest Endosc 2006;63(3):473-78.
            with early dislodgement of a PEG tube. NOTES do not  11. Clayman RV, Box GN, Abraham JB, et al. Transvaginal singleport
            signal the demise of traditional gastrointestinal surgery or  NOTES nephrectomy: Initial laboratory experience. J Endourol
            laparoscopy. It is plainly evident that further advances are  2007;21(6):640–644. J Gastrointest Surg (2008) 12:1293-1300
                                                                    1299.
            required before NOTES can be considered for widespread
                                                                12. Minitz Y, Cullen J, Falor E, Talamini MA. Dual Lumen NOTES:
            application.                                            A new method for performing a safe anastomosis. Surg Endosc
               Current endoscopic instruments are not yet appropriate  2007;21(Suppl 1):S333.
            for total NOTES, but they allow operations using a hybrid  13. Tsunada S, Ogata S, Ohyama T, et al. Endoscopic closure of
                                                                    perforations caused by EMR in the stomach by application of
            approach. Tools that help in retraction, exposure and
                                                                    metallic clips. Gastrointest Endosc 2003;57(7):948-51.
            dissection needs to be developed. An over tube with multiple  14. Marks J, McGee MF, Onders R, et al. Complete endoscopic
            channels or a multiple channel endoscope with deflecting  closure of gastrotomy following natural orifice translumenal
            channels that give good retraction and dissection is likely to  endoscopic surgery using the NDO Plicator. Surg Endosc
                                                                    2007;21(Supplement):S333.
            be of paramount value.
                                                                15. McGee MF, Marks JM, Onders RP, et al. Complete endoscopic
               Above all, regard for patient safety must prevail. Only  closure of gastrotomy after natural orifice translumenal
            those with vast laboratory experience with NOTES should  endoscopic surgery using the NDO Plicator. Surg Endosc 2007:
            contemplate clinical NOTES procedures. Initially, only  DOI 10.1007/ s00464-007-9565-5.
                                                                16. Mellinger JD, MacFadyen BV, Kozarek RA, et al. Initial
            patients enrolled in clinical trials should undergo NOTES.
                                                                    experience with a novel endoscopic device allowing intragastric
            To conclude NOTES is a precious raw diamond which       manipulation and plication. Surg Endosc 2007;21(6):
            needs to be further cut and polished.                   1002-05.

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