The diagnostic efficacy of natural orifice transluminal endoscopic surgery: is there a role in the intensive care unit?

Abstract

The utilization of NOTES as a diagnostic tool may have an important role in the critically ill patient when operative intervention is highly morbid. Although it may be overall inferior diagnostically compared with laparoscopy, a positive identification was highly specific with a strong predictive value. Further investigation addressing an improved small bowel evaluation technique would be beneficial. A human trial of NOTES in the ICU utilizing the current technology would still initially mandate laparoscopic or open surgical confirmation and treatment.

Diagnostic Laparoscopy in the Intensive Care Unit

“…30 Another study found that although NOTES was 100% specific for detection of intra-abdominal pathology, it was less sensitive than laparoscopy (63.1% vs 77.4%). 31 The NOTES has a potential to become another diagnostic maneuver for the ICU patients in whom regular laparoscopy is difficult to perform for various reasons, but perforation of the stomach to perform such an examination can lead to its own set of significant complications.…”

The ”FLEX” procedure: a new technique for full-thickness laparo-endoscopic excision in the colon

“…The prototype endoscope allows the operator to maneuver instruments passed through its working channels in perpendicular planes thereby improving tissue manipulation during exploration. One channel can be directed in a vertical plane while the opposing channel can move in a horizontal plane [7]. This allows greater precision in endoscopic dissection, especially when aided by traction placed on the tissues by an instrument introduced via the second endoscope.…”

Natural Orifice Transluminal Endoscopic Surgery (NOTES)-an Emerging Technique in Surgery

“…Transgastric peritoneoscopy for acute mesenteric ischaemia, assessment of the length of an ischaemic small bowel to make a decision for a laparotomy and in abdominal trauma patients to assess the degree of intra-abdominal injury is expected to be carried out Under sedation rather than general anaesthesia without transferring patients across to the operating theatres. 24 It is expected that, as this ſ eld develops, other specialties such as urology, obstetrics and gynecology, and cardiothoracic surgery may ſ nd the natural oriſ ce to be a kinder and gentler point of entry.…”