ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery: White Paper October 2005

doi:10.1016/j.gie.2005.12.007

Gastrointestinal Endoscopy

Volume 63, Issue 2, February 2006, Pages 199-203

https://doi.org/10.1016/j.gie.2005.12.007 Get rights and content

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Taxonomy

Although initial procedures have been performed via a transgastric route, it is conceivable that other routes of access to the peritoneal cavity may be preferable (such as transvaginal or transcolonic). The group therefore agreed that the term Natural Orifice Translumenal Endoscopic Surgery (NOTES) best described the emerging field. Inclusion of the word Surgery was felt to be essential because tissue resection and repair is the ultimate goal of accessing intraperitoneal organs. The

Fundamental challenges to the safe introduction of NOTES

The group was surveyed prior to gathering in New York about the potential barriers to performing NOTES, and each of these barriers was discussed in depth (Table 2). There were significant differences of opinion between surgeons and endoscopists of the importance of certain barriers, particularly prevention of intraperitoneal infection, the need to maintain spatial orientation, the need for a stable platform, and the management of intraperitoneal complications. There was immediate consensus on

NOTES: Moving forward

For NOTES to mature into a viable technology, both procedure and device development must continue. At this stage, NOTES must be performed by a team that has the skills of an advanced therapeutic endoscopist and a laparoscopic surgeon, who in many instances will bring unique but complementary skills. There are a number of other fundamental issues, many of which are detailed above, that need to be understood prior to the safe introduction of NOTES. These are best addressed in laboratory settings (

Acknowledgement

NOSCAR gratefully acknowledges the financial support of Olympus Corporation, InScope, a division of Ethicon Endosurgery, Inc., and CIMIT (Center for Integration into Medicine of Innovative Technology) for underwriting the costs of the NOSCAR Working Group Meeting in New York, NY, July 22-23, 2005.