Editorial
Copyright ©2010 Baishideng. All rights reserved.
World J Gastrointest Surg. Jun 27, 2010; 2(6): 177-178
Published online Jun 27, 2010. doi: 10.4240/wjgs.v2.i6.177
NOTES-Natural orifice transluminal endoscopic surgery: Why not?
Antonello Forgione
Antonello Forgione, AIMS Advanced International Mini-invasive Surgery Academy; Department of General and Emergency Surgery, Niguarda Ca’ Granda Hospital, Piazza Ospedale 3, Milan 20162, Italy
Author contributions: Forgione A solely contributed to this paper.
Correspondence to: Antonello Forgione MD, PhD, MBA, Department of General and Emergency Surgery, Niguarda Ca’ Granda Hospital, Piazza Ospedale 3, Milan 20162, Italy. antonello.forgione@aimsacademy.org
Telephone: +39-2-64447600 Fax: +39-2-64447603
Received: May 26, 2010
Revised: June 20, 2010
Accepted: June 24, 2010
Published online: June 27, 2010

Abstract

Since natural orifice transluminal endoscopic surgery (NOTES) was first described by Anthony Kalloo, it has attracted tremendous interest from surgeons and gastroenterologist all around the world. This special issue of the World Journal of Gastrointestinal Surgery explores the current possibilities and future potential of the most disruptive revolution in the field of surgery represented by the NOTES approach. In the future, new technologies developed for this approach and deeper insight into several gastrointestinal diseases will lead to the design of completely new interventional procedures and change the way we will operate, bringing us to the previously unimaginable goal of “no scar surgery”.

Key Words: Gastrointestinal surgery, Minimally invasive surgery, Natural orifice transluminal endoscopic surgery, Microrobotics



EDITORIAL

We, human beings, don’t like to undergo surgical procedures, not only for the fear and effect of the disease, but also for the expected postoperative pain, the risks and side effects of anesthesia, the recovery time needed after an operation and the permanent visible scars that will forever leave an unpleasant reminder of the experience and alter the esthetic of the person[1].

The revolutionary concept of natural orifice transluminal endoscopic surgery (NOTES) described by Kalloo et al[2], promises to overcome many of the historical drawbacks of the surgical approach.

After a long period of testing in experimental settings the NOTES approach has now proven its feasibility and safety in preliminary clinical experience in the performance of basic surgical procedures[3-5]. At same time, new fields of surgery and innovative approaches are being explored in order to allow more advanced procedures to be performed[6,7].

So far, the major efforts in the field have been primarily concentrated on the use of natural orifice approaches to simply replicate traditional radical procedures whilst respecting established operative strategies. However, the NOTES approach is also stimulating the appreciation of complementary advanced technologies and new surgical concepts, that will allow us not only to perform the procedures via a minimal access, but also to minimize the extent or even the need for a surgical resection. These new concepts are represented for example by genetically driven gastrointestinal cancer treatment and manipulation of the gastrointestinal tract for the cure of metabolic disorders[8-10].

In fact, Better genetic and physiopathological knowledge will help us to customize the surgical approach to the specific needs of the patient. This will avoid the usual “one size fits all” strategy that often relies on extended surgical resection of large specimens simply to perform the correct cancer staging. This approach rarely adds any clinical benefit to the patients while may impair their functional outcome and quality of life[11].

In this special issue of the World Journal of Gastrointestinal Surgery, leading experts in the field report on their current experimental and clinical experience with this new approach, such as “Natural orifice transluminal endoscopic surgery: The transvaginal route moving forward from cholecystectomy” by Targarona et al[12], “Transgastric cholecystectomy: From the laboratory to clinical implementation” by Dallemagne et al[13], “NOTES in the management of colorectal diseases: Current experience and future directions” by Sylla[14], “Natural orifice transluminal endoscopic surgery and localized resection for colorectal neoplasia” by Cahill et al[15], “NOTES: The question for minimal resection and sentinel node in early gastric cancer” by Asakuma et al[16], “Single access laparoscopic surgery: Complementary or alternative to NOTES?” by Dapri[17], “Natural orifice translumenal surgery: Flexible platform review” by Shaikh et al[18], “In vivo miniature robots for natural orifice surgery: State of the art and future perspectives” by Tiwari et al[19], and “Natural orifice transluminal endoscopic surgery: Educational challenge” by Dunkin[20]. All The authors in their articles, highlight how technological developments and new concepts will definitively push forward this previously unimaginable frontier of “no scar surgery”, allowing for its widespread application and the conception of completely new techniques that will greatly impact the way we will address many diseases in the future.

Footnotes

S- Editor Wang JL L- Editor Hughes D E- Editor Yang C

References
1.  Swanstrom LL, Volckmann E, Hungness E, Soper NJ. Patient attitudes and expectations regarding natural orifice translumenal endoscopic surgery. Surg Endosc. 2009;23:1519-1525.  [PubMed]  [DOI]
2.  Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004;60:114-117.  [PubMed]  [DOI]
3.  Zorrón R, Filgueiras M, Maggioni LC, Pombo L, Lopes Carvalho G, Lacerda Oliveira A. NOTES. Transvaginal cholecystectomy: report of the first case. Surg Innov. 2007;14:279-283.  [PubMed]  [DOI]
4.  Ujiki MB, Martinec DV, Diwan TS, Denk PM, Dunst CM, Swanström LL. Video: natural orifice translumenal endoscopic surgery (NOTES): creation of a gastric valve for safe and effective transgastric surgery in humans. Surg Endosc. 2010;24:220.  [PubMed]  [DOI]
5.  Rao GV, Reddy DN, Banerjee R. NOTES: human experience. Gastrointest Endosc Clin N Am. 2008;18:361-370; x.  [PubMed]  [DOI]
6.  Zorron R, Goncalves L, Leal D, Kanaan E, Cabral I, Saraiva P. Transvaginal hybrid natural orifice transluminal endoscopic surgery retroperitoneoscopy--the first human case report. J Endourol. 2010;24:233-237.  [PubMed]  [DOI]
7.  Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. 2010;24:1205-1210.  [PubMed]  [DOI]
8.  Cahill RA, Asakuma M, Trunzo J, Schomisch S, Wiese D, Saha S, Dallemagne B, Marks J, Marescaux J. Intraperitoneal virtual biopsy by fibered optical coherence tomography (OCT) at natural orifice transluminal endoscopic surgery (NOTES). J Gastrointest Surg. 2010;14:732-738.  [PubMed]  [DOI]
9.  Cahill RA, Lindsey I, Cunningham C. Address of early stage primary colonic neoplasia by N.O.T.E.S. Surg Oncol. 2009;18:163-168.  [PubMed]  [DOI]
10.  Rubino F, Schauer PR, Kaplan LM, Cummings DE. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393-411.  [PubMed]  [DOI]
11.  Forgione A, Leroy J, Cahill RA, Bailey C, Simone M, Mutter D, Marescaux J. Prospective evaluation of functional outcome after laparoscopic sigmoid colectomy. Ann Surg. 2009;249:218-224.  [PubMed]  [DOI]
12.  Targarona EM, Maldonado EM, Marzol JA, Marinello F. Natural orifice transluminal endoscopic surgery: The transvaginal route moving forward from cholecystectomy. World J Gastrointest Surg. 2010;2:179-186.  [PubMed]  [DOI]
13.  Dallemagne B, Perretta S, Allemann P, Donatelli G, Asakuma M, Mutter D, Marescaux J. Transgastric cholecystectomy: From the laboratory to clinical implementation. World J Gastrointest Surg. 2010;2:187-192.  [PubMed]  [DOI]
14.  Sylla P. NOTES in the management of colorectal diseases: Current experience and future directions. World J Gastrointest Surg. 2010;2:193-198.  [PubMed]  [DOI]
15.  Cahill RA, Mortensen NJ. Natural orifice transluminal endoscopic surgery and localized resection for colorectal neoplasia. World J Gastrointest Surg. 2010;2:199-202.  [PubMed]  [DOI]
16.  Asakuma M, Cahill RA, Lee SW, Nomura E, Tanigawa N. NOTES: The question for minimal resection and sentinel node in early gastric cancer. World J Gastrointest Surg. 2010;2:203-206.  [PubMed]  [DOI]
17.  Dapri G. Single access laparoscopic surgery: Complementary or alternative to NOTES? World J Gastrointest Surg. 2010;2:207-209.  [PubMed]  [DOI]
18.  Shaikh SN, Thompson CC. Natural orifice translumenal surgery: Flexible platform review. World J Gastrointest Surg. 2010;2:210-216.  [PubMed]  [DOI]
19.  Tiwari MM, Reynoso JF, Lehman AC, Tsang AW, Farritor SM, Oleynikov D. In vivo miniature robots for natural orifice surgery: State of the art and future perspectives. World J Gastrointest Surg. 2010;2:217-223.  [PubMed]  [DOI]
20.  Dunkin BJ. Natural orifice transluminal endoscopic surgery: Educational challenge. World J Gastrointest Surg. 2010;2:224-230.  [PubMed]  [DOI]