ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery

Excerpt

The growing capabilities of therapeutic flexible endoscopy have ushered in a new era in the treatment of gastrointestinal conditions. Refinements in laparoscopic surgery have progressed to the point that complex surgical procedures, such as gastric bypass, can now be performed in a minimally invasive fashion. These trends have set the stage for the development of even less invasive methods to treat conditions in both the gut lumen and in the peritoneal cavity. It seems feasible that major intraperitoneal surgery may one day be performed without skin incisions. The natural orifices may provide the entry point for surgical interventions in the peritoneal cavity, thereby avoiding abdominal wall incisions. In the first published description, Kalloo et al. [1] demonstrated the feasibility and safety of a per-oral transgastric endoscopic approach to the peritoneal cavity with long-term survival in a porcine model. This was soon followed by other transgastric peritoneal procedures in the porcine model, including tubal ligation, [2] cholecystectomy, [3] gastrojejunostomy, [4] splenectomy, [5] and oophorectomy with tubectomy [6, 7]. Although there are no publications, Rao et al. have described transgastric appendectomy in humans (personal communication). There have been two excellent editorials on this potentially emerging field. [8, 9] …