Natural-orifice transluminal endoscopic surgery

Atallah, S.; Martin‐Perez, B.; Keller, Deborah S.; Burke, John P.; Hunter, Lawna

doi:10.1002/bjs.9710

Cited by 77 publications

(58 citation statements)

References 193 publications

(240 reference statements)

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“…In hybrid NOTES, the omission of the minilaparotomy for organ retrieval may be associated with improved pain, recovery, wound complications and cosmetic outcomes. However, RCTs have yielded conflicting results, and opponents highlight the risk of access‐related complications.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of hybrid natural-orifice transluminal endoscopic surgery versus laparoscopic surgery

Steinemann

Müller

Probst

et al. 2017

British Journal of Surgery

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Section: Introductionmentioning

confidence: 99%

Meta-analysis of hybrid natural-orifice transluminal endoscopic surgery versus laparoscopic surgery

Steinemann

Müller

Probst

et al. 2017

British Journal of Surgery

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“…Unfortunately, this represents a fundamental flaw of NOTES that cannot be overcome, and it is not a sound logical syllogism to assume that visceral access trauma is less significant than abdominal access trauma [8]. Notwithstanding, there are important exceptions, such as when the visceral incision is part of the planned operation.…”

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confidence: 99%

Transanal total mesorectal excision: full steam ahead

Atallah¹

2015

Tech Coloproctol

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The article by Araujo [1] in this month's issue documents the dramatic climb of transanal total mesorectal excision (transanal TME) with the most comprehensive review on this topic to date and a revelation of published numbers that are approximately double what they were just 1 year ago [2]. While it may seem as if transanal TME materialized overnight, in actuality, its foundation had been quietly in development for three decades. The seeming sudden ascent of transanal TME is analogous to a building under construction. Developing a proper foundation is a time-intensive and critical first step. To naïve observers of a construction site, it may appear as though no progress is underway, until the foundation is completed and suddenly a building begins to rise ten stories high, filling in the skyline with striking speed.The foundation for transanal TME began 30 years ago with the innovative efforts of Gerald Marks and later carried on with his son John Marks. In the early 1980s, G. Marks pioneered the technique of what he termed the transabdominal-transanal (TATA) operation for rectal cancers involving the distal one-third of the rectum [3], performing a meticulous dissection from below and adapting Bill Heald's concept of TME, albeit 'in reverse.' This predated the era of laparoscopy and the first TATA operations were completed with an open approach before transitioning to the use of laparoscopic assistance in the 1990s [4]. For 30 years, Marks' TATA operation laid down the foundation for modern transanal TME, spelling out very clearly why this approach was preferred for distal rectal cancer. Principally, the advantages of TATA were (a) definition of the distal margin from below, thereby assuring no tumor involvement at the line of distal division and (b) obviating the need for stapling devices for transection, which do not comply with boney constraints ofin particular-the narrow male pelvis. Even when staplers could be negotiated into pelvic confines from above, there was still the risk of inadvertently stapling across tumor, thereby irreversibly compromising the oncologic integrity of the operation. While Marks' rationale behind TATA was perfectly on point, the technique required specialized retractors with limited exposure, and thus few were able to replicate this approach.In parallel with TATA, the transanal endoscopic microsurgery (TEM) scope was developed by Buess [5] and considerable experience was gained with TEM for local excision of rectal neoplasia, though primarily for nonmalignant lesions. TEM was, for many, an unaffordable privilege of the elite; most colorectal surgeons, to this day, are not privy to TEM nor have they had formal training with this exquisite device. TEM's penetration had remained limited due to prohibitive upfront costs and also the complexity it mandates from surgeons.During a recent lectureship webcast, a renowned colorectal surgeon remarked that, 'in [the year] 2000, TEM was dead.' This statement was not intended to discredit the otherwise precocious TEM marvel. Implicit, however,...

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“…In recent years, many surgeons have been trying to reduce the number of port incisions in order to limit potential complications such as wound infection and port‐site hernia . SALS and NOTES are at the cutting edge of surgical innovation, but NOTES has some technical limitations and restrictions in patient selection , which may explain the increasing interest in SALS procedures such as cholecystectomy . With regard to SALS rectal procedures, the first report presented by Hamzaoglu et al .…”

Section: Discussionmentioning

confidence: 99%