Natural Orifice Translumenal Endoscopic Surgery (NOTES)

Anthony N. Kalloo, Jacques Marescaux, Ricardo Zorron, Anthony N. Kalloo, Jacques Marescaux, Ricardo Zorron

• Publisher: Wiley-Blackwell
• Year: 2012
• Print ISBN: 9780470671030
• eBook ISBN: 9781118307939
• Edition: 1
• Topic: Medicine
• Subtopic: Gastroenterology & Hepatology

Are you interested in using NOTES to treat your patients? Do you need a multimedia tool to guide you through all aspects of clinical management?  

Just as laparoscopic surgery revolutionized surgical practice in the 1980's and 90's, offering genuine competition to traditional open surgery, Natural Orifice Translumenal Endoscopic Surgery (NOTES) presents a genuinely different alternative for surgeons and patients alike as we move forward in the 21st century.  Advantages over laparoscopic surgery include lower anesthesia requirements, faster recovery and shorter hospital stays, avoidance of transabdominal wound infections, less immunosuppression, better postoperative pulmonary and diaphragmatic function and of course, the potential for "scarless" abdominal surgery.

Combining high-level text with a superb companion website, Natural Orifice Translumenal Endoscopic Surgery (NOTES): Textbook and Video-Atlas provides you with a hands-on, in-depth and practical multimedia tool on this exciting breakthrough, to consult either on the ward or in surgery. Highlights include:

• Full coverage of the fundamentals of NOTES, its current clinical applications and techniques, and future perspectives
• Over 50 outstanding videos illustrating NOTES being performed by the experts
• Full-color throughout and superbly illustrated with over 250 figures
• Edited by global leaders and pioneers in the field, who have recruited a world-class contributor team

 As well being a valuable text for gastroenterologists, GI surgeons and general surgeons, Natural Orifice Translumenal Endoscopic Surgery (NOTES): Textbook and Video-Atlas will also appeal to urologists, urologic surgeons, gynecologists, gynecologic surgeons, thoracic and ENT surgeons.

1
Development of the NOTES Concept

1

History of NOTES

Xavier Dray^1,2 & Anthony N. Kalloo²

¹APHP Hôpital Lariboisière & Université Paris 7, Paris, France

²The Johns Hopkins Hospital, Baltimore, MD, USA

Natural orifice translumenal endoscopic surgery (NOTES) is an endoscopic technique whereby surgical interventions can be performed with a flexible endoscope passed through a natural orifice (mouth, vulva, urethra, anus) then through a translumenal opening of the stomach, vagina, bladder, or colon [1]. NOTES has the potential to provide no scarring, reduced pain, and faster patient recovery compared to open and laparoscopic surgical procedures [1]. We present herein the landmarks in the history of NOTES, from the early stages of endoscopy and laparoscopy to its current development.

Prehistory of NOTES (from Ancient Times to the Late Twentieth Century)

It is difficult to date when people started to have a look into human bodies, and even harder to credit one individual with the invention of endoscopy. The earliest descriptions of endoscopy are by Hippocrates (460–375 BC), who described a rectal speculum. A three-bladed vaginal speculum was found in the ruins of Pompeii, demonstrating that Roman medicine also involved primitive endoscopic tools. At this time, nothing but ambient light was used, and only rigid instruments were available. Major technological developments leading to modern endoscopy and to modern laparoscopy were born in the nineteenth and twentieth centuries [2].

A Brief History of Endoscopy [3]

The first issue faced by the pioneers of endoscopy was the illumination problem. The first gastroscopy was reported by Kussmaul in 1868 [4]. Joseph Swan and Thomas Edison invented the incandescent electric light bulb in 1878, but this technology was incorporated into endoscopes only at the beginning of the twentieth century [3].

The second and more challenging problem was flexibility. Articulated lenses and prisms were proposed by Hoffmann in 1911 [5] and improved in 1932 by Wolf and Schindler, who developed a semi-flexible gastroscope [6]. However, the light source consisted of a distal light bulb that provided poor illumination and produced color distortion. In 1930, Lamm showed that bundles of glass fibers could be used as a conduit for a light source, and that this bundle could be bent with no effects on light transmission [7]. “Coherent” bundles, ordered in such a way that the position of a fiber at one end mirrors its position at the other end, provided a real image of internal organs [8]. An external light source transmitted through flexible and coherent fiber bundles could therefore illuminate internal organs.

Flexibility and illumination were combined by Harold Hopkins in 1954: the flexible fiber imaging device he invented was made of a tube of glass with thin lenses of air [9]. In 1958, Larry Curtiss and Basil Hirschowitz improved this system by using a highly transparent optical quality glass to give birth to a flexible fiberoptic endoscope [10].

In the late 1970s, the charge-coupled device (CCD) was incorporated into an endoscope [11]. This development heralded the modern era of endoscopy. The CCD allowed the display of endoscopic images on television screens and the connection of endoscopes and computers. From this major shift started a two-decade period described by Sivak as “the golden era of gastrointestinal endoscopy” [3]. Major achievements, which have since become routine procedures, were reported: endoscopic retrograde pancreatography (1968), colonoscopic polypectomy (1969), endoscopic retrograde cholangiography (1970), endoscopic sphincterotomy with bile duct stone removal (1974), percutaneous endoscopic gastrostomy (1980), endoscopic injection sclerotherapy (1980), endoscopic ultrasonography (1980), electronic CCD endoscope (1983), endoscopic control of upper gastrointestinal bleeding (1985), and endoscopic variceal ligation (1990) [3]. Modern endoscopy was born.

A Brief History of Minimally Invasive Surgery

Georg Kelling (Dresden, Saxony) reported on the first laparoscopic procedure in animals in 1902. Hans Christian Jacobaeus (Sweden) performed the first laparoscopic operation in humans in 1910. Many refinements were brought to the technique over decades. However, diagnosis and simple gynecologic procedures were the main applications [2]. A landmark in this early period of laparoscopy is the first diagnostic laparoscopy by Palmer in the 1950s [12]. In the 1960s gynecologists took up interventional laparoscopy. The first CO₂ hysteroscopy was reported by Frangenheim and Semm in the mid-1970s [2]. Tarasconi (Ob-Gyn, Passo Fundo, Brazil) reported on the first laparoscopic organ resection (salpingectomy) in 1976, since published in 1981 [13]. Kurt Semm (Kiel, Germany) performed the first laparoscopic appendectomy in 1981. Although he is now considered as one of the fathers of modern laparoscopy, he first met great skepticism and even scorn [14]. His suspension from medical practice was debated in the German Gynecological Society. The paper that he submitted on “endoscopic appendectomy” to the American Journal of Obstetrics and Gynecology was initially deemed unethical and was rejected. Semm persevered, introduced thermocoagulation, and developed many standard laparoscopic gynecologic procedures, including ovarian cyst enucleation, myomectomy, treatment of ectopic pregnancy, and laparoscopic-assisted vaginal hysterectomy. He published hundreds of papers on laparoscopy, established a company of laparoscopic instruments, and built the widely used pelvi-trainer [14]. By the end of the 1980s, laparoscopy was widely accepted in gynecology, but few general surgeons had included laparoscopy in their practice. The first lap-cholecystectomy was made by Erich Muhe (Erlangen, Germany) in 1986. Muhe met a lot of misunderstanding from his colleagues at this time, and even faced a lawsuit for “improper surgical action” [15]. The use of the computer chip TV camera in 1986 led to the era of modern laparoscopy: not only was a view of the operative field magnified onto a monitor, but also the surgeon could stand upright, and both his/her hands were free. Complex laparoscopic procedures were then developed. Philippe Mouret (Lyon, France) performed the first video-assisted laparoscopic cholecystectomy in 1987. Mouret mentored Dubois (Paris, France), Perissat (Bordeaux, France), and other collaborators. The so-called “French connection” made the laparoscopic technique more and more popular [16]. The first US laparoscopic cholecystectomy was performed in 1988. In the early 1990s, laparoscopic cholecystectomy was an accepted routine procedure. A dramatic explosion of laparoscopic applications occurred in the 1990s. Among others, landmarks in the history of laparoscopy are the first descriptions of truncal vagotomy [17], nephrectomy [18], Billroth II gastrectomy [19], and splenectomy [20]. Similar developments have been achieved in thoracic surgery in the past 30 years. Minimally invasive surgery is now seen as one of the greatest achievements in the recent history of medicine.

On the Verge of NOTES (1980–2000)

Translumenal Endoscopic Approaches

From the 1980s to the 2000s, numerous translumenal endoscopic procedures emerged. Some of them are now part of the routine practice of gastrointestinal endoscopy. Various endoscopic techniques consist of the creation of an artificial external opening into the digestive tract for nutritional support or gastrointestinal decompression. Percutaneous endoscopic gastrostomy (PEG) creation without laparoscopic assistance was first reported in 1980 by Gauderer et al. [21], then followed by variations such as percutaneous endoscopic jejunostomy and colostomy [22,23]. Endoscopic ultrasound (EUS) arose in 1980 [24]. Diagnostic EUS procedures were first based on imaging and Doppler only. Under EUS guidance, the fine needle aspiration (FNA) technique was developed to allow the sampling of lesions through the digestive wall [25]. EUS-FNA is now commonly used to target lesions in the mediastinum, in the biliary and pancreatic area, and in the mesorectum. Further refinement of the EUS technique has led to the ability to pass instruments (guidewires, fiducials, coils, radioactive seeds, pharmacological agents) using fine needles, leading to the concept of interventional EUS. Biliary, pancreatic, and vascular therapeutic EUS techniques are currently under evaluation [26].

Translumenal per-oral endoscopic access to the retroperitoneum is another gastrointestinal technique preceding the birth of NOTES. It was first described by Hans Seifert (Oldenburg, Germany) in 2000 [27]. After endoscopic transmural drainage of peripancreatic fluid collections is performed with EUS-FNA and wire-guided stent placement, the same transgastric access is expanded with balloon dilatation. The endoscope is advanced through the gastrointestinal wall into the retroperitoneum. Endoscopic removal of infected pancreatic necroses can be achieved under direct visual control. In a multicenter open study, initial clinical success was obtained in 80% of 93 patients, with a 26% complication and a 7.5% mortality rate at 30 days [28]. Similar results were found in a US multicenter study that included 104 patients [29]. Although not compared to surgery in randomized controlled studies, this endoscopic technique has become a valid therapeutic option. The concept of endoscopic debridement of necrosis was expanded to other conditions than pancreatitis and is now performed in expert centers to treat complications of postoperative leakage and fistula [30]. Although PEG, FNA-EUS, and endoscopic drainage of necrosis are definitely translumenal endoscopic procedures conducted through natural orifices they are not considered as true NOTES procedures as the endoscope is not advanced in the free peritoneal or thoracic cavity.

Transvaginal Laparoscopy

Transvaginal hydrolaparoscopy is a surgical technique that arose in the 1990s with the main purpose of diagnosing and treating infertility in women. The technique used a modified rigid and reusable laparoscope. The so-called “fertiloscopy” procedure combines a hydrolaparoscopy advanced through the vagina and the pouch of Douglas together with hysteroscopy and salpingoscopy with dye. A pioneer in this field is Antoine Watrelot...

Table of contents

• Cover
• Companion website
• Title page
• Copyright page
• Contributors
• Preface
• Section 1: Development of the NOTES Concept
• Section 2: Current Clinical Applications and Techniques
• Section 3: Perspectives on NOTES
• Index