Natural Orifice Translumenal Endoscopic Surgery™ (NOTES®) is a new type of surgical procedure currently being studied at research hospitals and facilities around the world. The idea of NOTES® was developed several years ago in response to the concepts that patients would 1) realize the benefits of less invasive surgery by reducing the recovery time, 2) experience less physical discomfort associated with traditional procedures and, 3) have virtually no visible scarring following this type of surgery. All of these advantages have spurred research and investigation forward, encouraging physicians and researchers to develop new equipment and techniques to use during NOTES® procedures.
As an example, in natural orifice surgery the gallbladder might be removed through the mouth. The doctor would insert a tube down the esophagus, make a small incision in the stomach or digestive tract to gain access to the abdominal cavity and take the organ out by the same route. A range of procedures might be performed this way, such as gastric bypass, fallopian tubal ligation, removal of the ovaries and diagnostic work. Some operations might be done via the rectum, vagina, urethra or bladder as well.
Because NOTES® is so new, research generally has been confined to animals, mainly pigs. Recently, however, human studies have emerged that report the procedures to be highly successful. Further studies involving a variety of procedures, under close supervision by medical experts and review boards, are being performed.
While this new series of procedures may seem a bit unorthodox, the safety and care of the patient is in the forefront as this technology develops. Constant oversight is in place to ensure the outcomes are monitored thoroughly and the new procedures are genuinely better than those currently used. Over time, NOTES® procedures will be evaluated by physicians and patients; future use will be determined by the facts and results of the studies being conducted now.
The NOTES® initiative is a joint effort of the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for American Gastrointestinal Endoscopic Surgeons (SAGES). Together, these societies have formed the Natural Orifice Surgery Consortium for Assessment and Research™ (NOSCAR® ), a group that provides guidance and oversight and evaluation of NOTES® techniques and the related research required.