Safe alternative transgastric peritoneal access in humans: NOTES

A review of 130 humans enrolled in transgastric NOTES protocols at a single institution

“…The method used for the establishment of endoscopic access to the peritoneal cavity has been previously described [9]. The initial study evaluated the endoscopic creation of a gastrotomy using laparoscopic guidance.…”

“…Next, we addressed the viability of this technique as a standalone approach to accessing the abdomen [9,10]. In a total of 60 patients, endoscopic transgastric access was successfully established without laparoscopic guidance.…”

“…The next protocols evaluated TEP in 60 patients scheduled for a LSRYGB procedure [9,10]. There were no quadrants of the abdomen or previous operations that were unable to be visualized endoscopically.…”

“…With that said, the preponderance of data for the therapeutic application of NOTES currently available in humans incorporates the transvaginal approach. Presently, there are only six publications from North America on transgastric NOTES protocols in a human population [7][8][9][10][11][12]. Natural orifice surgery may represent the next permutation in minimally invasive techniques, marking a shift from the laparoscopic or open approach.…”

Cholecystectomy: evolution of laparoscopic approach

“…P. Nau и соавт. отметили, что при этом травм кишечника зафиксировано не было, а у пациентов, оперирован-ных без предварительной лапароскопической под-держки, имелись единичные термические ожоги пе-чени, которые были обнаружены во время ревизии через трансабдоминальный порт [158]. Большин-ство TGC было выполнено гибридным способом с лапароскопической визуализацией точки доступа для предотвращения травмы близлежащих органов или желудочно-сальниковых сосудов в связи со зна-чительными сложностями трансгастральной визуа-лизации возможных осложнений [43].…”