Natural orifice transluminal endoscopic surgery (NOTES): where are we going? A bibliometric assessment

Abstract

What's known on the subject? and What does the study add? The safe and successful development of NOTES has the potential to create a paradigm shift in minimally invasive surgery. However, anecdotal diagnostic and therapeutic NOTES procedures, many of which were strictly performed in an investigative fashion, have taught us that continued, focused translational research is imperative to address myriad, and as yet unaddressed, technical issue. This study analyses the NOTES‐related research in the medical literature over the last 5 years in an attempt to identify trends and/or progress towards its meaningful use. It shows that NOTES is still in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. Since the first description of the concept of NOTES, >2000 clinical cases, irrespective of specialty, have been reported. NOTES remains a field of intense clinical and experimental research in various surgical specialties. The aim of this study was to analyse natural orifice transluminal endoscopic surgery (NOTES)‐related publications over the last 5 years. A systematic literature search was done to retrieve publications related to NOTES from 2006 to 2011. The following variables were recorded: year of publication; article type; study design; setting; Journal Citation Reports® journal category; authors area of surgical speciality; geographic area of origin; surgical procedure; NOTES technique; NOTES access route; number of clinical cases. A time‐trend analysis was performed by comparing early (2006–2008) and late (2009–2011) study periods. Overall, 644 publications were included in the analysis and most papers were found in general surgery journals (50.9%). Studies were most frequently clinical series (43.9%) and animal experimental (48%), with the articles focusing primarily on cholecystectomy, access creation and closure, and peritoneoscopy. Pure NOTES techniques were performed in most of the published reports (85%) with the remaining cases being hybrid NOTES (7.4%) and NOTES‐assisted procedures (6.1%). The access routes included transgastric (52.5%), transcolonic (12.3%), transvesical (12.5%), transvaginal (10.5%), and combined (12.3%). From the early to the late period, there was a significant increase in the number of randomised controlled trials (5.6% vs 7.2%) or non‐randomised but comparative studies (5.6% vs 22.9%) (P < 0.001) and there was also a significant increase in the number of colorectal procedures and nephrectomies (P = 0.002). Pure NOTES remained the most studied approach over the years but with increased investigation in the field of NOTES‐assisted techniques (P = 0.001). There was also a significant increase in the adoption of transvesical access (7% vs 15.6%) (P = 0.007). NOTES is in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. Since the first description of the concept of NOTES, >2000 clinical cases, irrespective of specialty, have been reported. NOTES remains a field of intense...

Current Evidence in Gastrointestinal Surgery: Natural Orifice Translumenal Endoscopic Surgery (NOTES)

“…However, with the current literature and application, no conclusions can be drawn about the overall safety, efficacy, or superiority of NOTES in surgery. 15 To assure that the technology is effective and efficient, the future of NOTES requires careful laboratory investigation with subsequent IRB-approved clinical trials. Appropriate equipment development and standardized methods of visceral entry and closure would aid acceptance of NOTES.…”

“…However, most published studies remain clinical series (43.9 %) and experimental animal reports (48 %), with the articles focusing primarily on cholecystectomy, access creation/closure, and peritoneoscopy. 15 With the abundance of safety and feasibility studies, the question remains why NOTES has not progressed further into clinical practice. In humans, only about 43 reports covering 432 NOTES cases have been reported.…”

“…A PubMed© search of NOTES from 2004 to the present yielded over 600 publications, with more than half published in general surgery journals (50.9 %). 15 The transgastric, transrectal, transcolonic, transanal, transvesical, and transesophageal approaches have been feasible for a variety of procedures, including cholecystectomy, hepatectomy, splenectomy, nephrectomy, gastrojejunostomy, gastric sleeve resection, tubal ligation, distal pancreatectomy, and colectomy. However, most published studies remain clinical series (43.9 %) and experimental animal reports (48 %), with the articles focusing primarily on cholecystectomy, access creation/closure, and peritoneoscopy.…”

“…Current major routes described in all reports include transgastric (52.5 %), transcolonic (12.3 %), transvesical (12.5 %), transvaginal (10.5 %), and combined (12.3 %). 15 In human subjects, the main access routes were transvaginal (84 %), transgastric (13 %), transesophageal (4 %), and transrectal (<1 %). 16 The transgastric approach uses endoscopic balloon dilatation, sphincterotome, or needle knife cautery to create and dilate a hole on the anterior stomach wall for introduction of the operating platform.…”

Transumbilical endoscopic cholecystectomy in a porcine model

“…Recent innovations have employed natural orifice transluminal endoscopic surgery (NOTES) to accomplish laparoscopic procedures. NOTES uses transvisceral access to the peritoneal cavity through the mouth, colon, urinary tract or vagina by using either rigid or flexible instruments 5 .…”