scholarly journals Transvaginal Laparoscopically-Assisted Endoscopic Appendectomy: A Major Hybrid Natural Orifice Transluminal Endoscopic Surgery Case Series in Asia

2016 ◽  
Vol 101 (3-4) ◽  
pp. 153-160 ◽  
Author(s):  
Abdul Qadir Khan ◽  
Enyu Liu ◽  
Weibo Niu ◽  
Peng Li ◽  
Hazrat Gul ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Laparoscopic Appendectomy ◽  
Endoscopic Surgery ◽  
Surgical Procedure ◽  
Hybrid Approach ◽  
Case Series ◽  
Hybrid Technique ◽  
Natural Orifice ◽  
Conventional Laparoscopic ◽  
Hybrid Notes

This paper represents an evaluation of a hybrid approach to natural orifice transluminal endoscopic surgery (NOTES) and its performance relative to conventional procedures. Globally, numerous institutions have successfully implemented minimally invasive surgeries by applying NOTES techniques and achieved decreased morbidity while performing incision-less surgery. However, these techniques are still not common in surgical practice in China and Pakistan. Documenting the experiences and challenges encountered in implementing NOTES in such environments can provide guidance for NOTES implementation elsewhere. From May 2010 to April 2012, 16 human transvaginal appendectomies were carried out applying a hybrid NOTES technique using a solo-umbilical trocar, which provided a safe access for laparoscopic assistance during surgical procedure. After removal of the appendix transvaginally, the colpotomy was sutured under direct vision with absorbable stitches. The outcomes of cases treated with hybrid NOTES techniques were compared to those of conventional laparoscopic appendectomy. All patients underwent a successful surgical procedure with no intra- or postoperative complications and provided no specific complaints during the 10th day and a monthly follow-up for 2 years. The patients convalesced promptly with healthy and satisfactory cosmetic results. Compared to conventional laparoscopic appendectomy, the hybrid NOTES operation had less postoperative pain, lower cost, and shorter hospitalization. Hybrid NOTES procedures can be performed safely using a solo-umbilical trocar. Our initial experience reveals that this hybrid technique is practically feasible and associated with minimal postoperative pain, reasonable convalescence time, and improved cosmetic outcomes.

scholarly journals Robotics for Natural Orifice Transluminal Endoscopic Surgery: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Xiaona Wang ◽  
Max Q.-H. Meng
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Pain ◽  
Endoscopic Surgery ◽  
Surgical Procedure ◽  
State Of The Art ◽  
Abdominal Cavity ◽  
Natural Orifice ◽  
Robotic Platforms ◽  
Flexible Instruments ◽  
Natural Orifices

Natural Orifice Transluminal Endoscopic Surgery (NOTES) involves accessing the abdominal cavity via one of the bodies’ natural orifices, for example, mouth, anus, or vagina. This new surgical procedure is very appealing from patients’ perspectives because it eliminates completely abdominal wall aggression and promises to reduce postoperative pain, in addition to all other advantages brought by laparoscopic surgery. However, the constraints imposed by both the mode of access and the limited technology currently available make NOTES very challenging for the surgeons. Redesign of the instruments is imperative in order to make this emerging operative access safe and reproducible. In this paper, we survey on the state-of-the-art devices used in NOTES and introduce both the flexible instruments based on improvement of current endoscopic platforms and the revolutionary concept of robotic platforms based on the convergence of communication and micromechatronics technologies. The advantages and limitations of each category are addressed. Potential solutions are proposed to improve the existing designs and develop robust and stable robotic platforms for NOTES.

Natural Orifice Transluminal Endoscopic Surgery: Long-Term Experience with Hybrid Transvaginal Cholecystectomies

2020 ◽  
pp. 155335062093240
Author(s):  
Fabian Rössler ◽  
Andreas Keerl ◽  
Uwe Bieri ◽  
Juliette Slieker ◽  
Antonio Nocito
Keyword(s):  
Endoscopic Surgery ◽  
Special Focus ◽  
Complication Rates ◽  
Natural Orifice ◽  
Comprehensive Complication Index ◽  
Transvaginal Cholecystectomy ◽  
Gynecological Examination ◽  
Transvaginal Access ◽  
Standard Laparoscopic Cholecystectomy ◽  
Hybrid Notes

Objective. To assess outcome and safety of 571 hybrid natural orifice transluminal endoscopic surgery (NOTES) cholecystectomies. Methods. We retrospectively analyzed all consecutive NOTES cholecystectomies performed at our center between June 2009 and January 2018. All procedures were performed using a hybrid transvaginal technique, including an umbilical small-size trocar. End points, calculated at discharge, 30 and up to 90 days postoperatively, included intra- and postoperative morbidity assessed by the validated Clavien–Dindo classification and the Comprehensive Complication Index (CCI). Special focus was held on outcome and necessity of pre- and postoperative gynecological examinations. Results. We performed 571 hybrid NOTES cholecystectomies within 9 years. The vast majority were elective, 9.6% were emergency cholecystectomies. 6.7% of patients developed at least one complication until discharge, most of them minor (≤grade II). 30- and 90-day complication rates were 10.7% and 11%, respectively. Mean CCI at discharge and postoperative days 30 and 90 was 1.45 (±6.4), 2.3 (±7.7), and 2.4 (±7.8), respectively. Major complications (≥grade IIIa) occurred in 1.6% of patients, and 4 patients required emergency reoperation. No mortality was observed. In 9.8%, an additional abdominal trocar was placed. All patients underwent routine gynecological examination, whereof only 5 were rejected for transvaginal access preoperatively. In no case transvaginal access was discontinued intraoperatively due to gynecological disease. Conclusion. Hybrid NOTES transvaginal cholecystectomy represents a safe and feasible alternative to standard laparoscopic cholecystectomy. Preoperative gynecological examination is no longer routinely necessary, as intraoperative assessment is adequate.

scholarly journals Natural Orifice Transluminal Endoscopic Surgery

2009 ◽  
Vol 91 (6) ◽  
pp. 456-459 ◽  
Author(s):  
T Arulampalam ◽  
S Paterson-Brown ◽  
AJ Morris ◽  
MC Parker
Keyword(s):  
Clinical Research ◽  
Endoscopic Surgery ◽  
General Public ◽  
Consensus Statement ◽  
Medical Profession ◽  
Current Status ◽  
Natural Orifice ◽  
Novel Method ◽  
Hybrid Notes ◽  
And Training

Natural orifice transluminal endoscopic surgery (NOTES) has generated healthy and vigorous debate about the introduction of an entirely novel method of surgical therapy. Although there are many reasons for scepticism, there is undoubted interest in this field from both the medical profession and general public. Those Associations currently involved in laparoscopic and endoscopic surgery wish to safeguard patients and the reputation of the profession by issuing clear guidance and support for those wishing to undertake NOTES. The purpose of this document is to review the current status of both NOTES and hybrid NOTES, while at the same time identifying obstacles in both clinical research and training. Furthermore, it aims to provide a consensus statement on behalf of the main UK specialty associations involved in this field of surgery. The primary aim of this consensus statement is to provide a framework within which to develop, safely and effectively, what must still be considered an experimental technique.

scholarly journals Subcutaneous Endoscopy in Plastic and Reconstructive Surgery

2021 ◽  
Author(s):  
Bharatendu Swain
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Endoscopic Surgery ◽  
Reconstructive Surgery ◽  
Single Port ◽  
Case Series ◽  
High Patient Satisfaction ◽  
Intraoperative Bleeding ◽  
Wide Range ◽  
Scar Visibility

Abstract Background Scar visibility is a major deterrent to patients seeking reconstructive surgery. Endoscopic surgery can address a wide range of problems, from minimizing or concealing scars to improving access and outcomes in certain situations. This case series includes a wide range of reconstructive surgery problems addressed by subcutaneous endoscopic surgery. Having one or more trained assistants is a major deterrent to the performance of endoscopic surgery by the lone practitioner. The single (or two-port technique for muscle harvest) used in most cases simplifies subcutaneous endoscopic surgery. Methods A single-port endoscopy technique, with a 4-mm, 30-degree side viewing telescope and sheath, optical camera and cold light source, was used. Case records were reviewed for access incisions, procedure abandonment, postoperative pain, complications, and patient satisfaction. Results A total of 53 endoscopic surgical episodes between 2003 and 2013 were reviewed. Using a single port, most cases were done successfully. The access site was changed peroperatively in one case. Complications included transient nerve palsy in one case, which recovered completely. There was minimal intraoperative bleeding. Postoperative pain was low except in one case and managed with minimal analgesia. Patient satisfaction was high in all cases. Conclusions Subsurface endoscopy done on a wide range of reconstructive surgery procedures and resulted in minimal scars and high patient satisfaction.

scholarly journals Is the scar-less hysterectomy with Natural Orifice Transluminal Endoscopic Surgery (NOTES) the future of benign gynecological surgery? A Review of the literature

2020 ◽  
Vol 8 (11) ◽  
Author(s):  
Rebecca Karkia ◽  
T Giachino ◽  
H Ahmed
Keyword(s):  
Postoperative Pain ◽  
Minimally Invasive ◽  
Endoscopic Surgery ◽  
Recovery Time ◽  
Surgical Approaches ◽  
Gynecological Surgery ◽  
Review Of The Literature ◽  
Natural Orifice ◽  
Traditional Methods ◽  
Minimally Invasive Surgical

As the tide advances towards minimally invasive surgical approaches which are favourable over open methods in terms of patient analgesia requirements and recovery time, Natural Orifice Transluminal Endoscopic Surgery (NOTES) has emerged as a technique within gynaecology which uses laparoscopic instruments and methods without the need for abdominal incisions. NOTES surgery has been conducted within gynecology via a vaginal colpotomy to perform procedures such as adnexectomy, hysterectomy, myomectomy and urogynecological procedures. This review summarises the available literature data on NOTES surgery with preliminary results showing reduced postoperative pain, improved cosmesis, and the potential for faster patient recovery and hospital discharge as compared to traditional methods. Larger, more robust data is needed to truly compare the efficacy of gynecological NOTES over traditional methods, however initial literature suggests this may be a promising innovation emerging in the field of gynecology.

Application of transanal extraction of specimen by laparoscopic surgery in treatment of rectal cancer

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Viết Hùng Trần ◽  
Anh Vũ Phạm ◽  
Anh Vũ Phạm
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Endoscopic Surgery ◽  
Anterior Resection ◽  
Rectal Adenocarcinoma ◽  
Natural Orifice ◽  
Natural Orifice Specimen Extraction ◽  
Hybrid Notes ◽  
Pull Through ◽  
Transanal Extraction

Tóm tắt Đặt vấn đề: Phẫu thuật nội soi qua đường tự nhiên (NOTES: Natural orifice transluminal endoscopic surgery) và phẫu thuật nội soi truyền thống nhưng lấy bệnh phẩm qua ngả tự nhiên (Hybrid NOTES) là bước phát triển mới trong phẫu thuật ít xâm lấn điều trị ung thư đại trực tràng. Song nó vẫn chưa được phát triển rộng rãi trên thế giới cũng như ở Việt Nam. Nghiên cứu này nhằm mục đích đánh giá kết quả bước đầu phẫu thuật cắt ung thư trực tràng nội soi lấy bệnh phẩm qua đường tự nhiên. Phương pháp nghiên cứu: nghiên cứu tiến cứu. Đối tượng nghiên cứu gồm 32 người bệnh ung thư biểu mô tuyến trực tràng giai đoạn T≤3, N≤1, M0 được phẫu thuật từ 10/2012 đến 09/2015 tại BVTW Huế. Phương pháp nghiên cứu: phẫu thuật được tiến hành trên hai phương thức Hybrid NOTES(A) và NOTES(B) với ba kỹ thuật: cắt trước (AR: anterior resection), trước thấp (LAR: low anterior resection) và xuyên cơ thắt (Pull-through). Kết quả: Tất cả 32 người bệnh đều được phẫu thuật thành công cắt ung thư trực tràng nội soi lấy bệnh phẩm qua đường tự nhiên, không có trường hợp nào phải chuyển mổ mở. 3 trường hợp trong nhóm NOTES có tai biến chảy máu và thủng niệu đạo, phải đặt thêm trocar hỗ trợ và không có trường hợp nào tử vong. Thời gian phẫu thuật nhóm Hybrid NOTES là 194±47(120-280) phút, nhóm NOTES là 258±40(190-300) phút. Thời gian nằm viện: 9±2,7(4-19) ngày. Kết luận: Phẫu thuật cắt ung thư trực tràng nội soi lấy bệnh phẩm qua đường tự nhiên bước đầu cho thấy khả thi và an toàn trên cả hai phương thức: phẫu thuật nội soi đường bụng lấy bệnh phẩm qua ngả tự nhiên Hybrid NOTES và phẫu thuật hoàn toàn qua lỗ tự nhiên NOTES. Abstract Introduction: Transanal extraction of specimen by laparoscopic surgery for rectal cancer composed of Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Hybrid NOTES nowadays is an important evaluation in minimally invasive for colorectal cancer surgery. However, it has not implemented commonly on over the world. This research is to evaluate the outcome of the technique in treatment of rectal cancer. Material and Methods: Prospective study was conducted from 10/2012 to 09/2015 in 32 patients diagnosed with rectal adenocarcinoma staging T≤3, N≤1, M0 and were operated using one of two modalities Hybrid NOTES (A) and NOTES (B) with three techniques: AR, LAR and Pull-through. Results: Thirty-two patients with rectal cancer were successfully operated by Hybrid NOTES and NOTES procedures. Three cases in group NOTES that had per-operative complications such as bleeding or urethra injury were required one or two additional trocars to complete the procedure, no conversion to open surgery and no mortality. The operation duration: group A (Hybrid NOTES): 194±47 (120-280) minutes; group B (NOTES): 258±40 (190-300) minutes. The length of hospital stay: 9±2.7 (4-19) days. Conclusion: Laparoscopic rectal resection with natural orifice specimen extraction for rectal cancer composed of Natural orifice transluminal endoscopic surgery (NOTES) and Hybrid NOTES is feasible and safe. However, a study in a large number of patient and long follow-up is necessary. Keyword: Natural orifice transluminal endoscopic surgery (NOTES), Hybrid NOTES, rectal cancer.

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