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Surgical Endoscopy

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01-05-2013 | Consensus Statement

Euro-NOTES Status Paper: from the concept to clinical practice

Authors: K. H. Fuchs, A. Meining, D. von Renteln, G. Fernandez-Esparrach, W. Breithaupt, C. Zornig, A. Lacy

Published in: Surgical Endoscopy | Issue 5/2013

Abstract

Background

The concept of natural orifice transluminal endoscopic surgery (NOTES) consists of the reduction of access trauma by using a natural orifice access to the intra-abdominal cavity. This could possibly lead to less postoperative pain, quicker recovery from surgery, fewer postoperative complications, fewer wound infections, and fewer long-term problems such as hernias. The Euro-NOTES Foundation has organized yearly meetings to work on this concept to bring it safely into clinical practice. The aim of this Euro-NOTES status update is to assess the yearly scientific working group reports and provide an overview on the current clinical practice of NOTES procedures.

Methods

After the Euro-NOTES meeting 2011 in Frankfurt, Germany, an analysis was started regarding the most important topics of the European working groups. All prospectively documented information was gathered from Euro-NOTES and D-NOTES working groups from 2007 to 2011. The top five topics were analyzed.

Results

The statements of the working group activities demonstrate the growing information and changing insights. The most important selected topics were infection issue, peritoneal access, education and training, platforms and new technology, closure, suture, and anastomosis. The focus on research topics changed over time. The principle of hybrid access has overcome the technical and safety limitations of pure NOTES. Currently the following NOTES access routes are established for several indications: transvaginal access for cholecystectomy, appendectomy and colon resections; transesophageal access for myotomy; transgastric access for full-thickness small-tumor resections; and transanal/transcolonic access for rectal and colon resections.

Conclusions

NOTES and hybrid NOTES techniques have emerged for all natural orifices and were introduced into clinical practice with a good safety record. There are different indications for different natural orifices. Each technique has been optimized for the purpose of finding a safe and realistic solution to perform the procedure according to the specific indication.

Rattner D, Kalloo AN , ASGE/SAGES working Group (2006) White paper on natural orifice translumenal endoscopic surgery. Surg Endosc 20(2):329–333

Rattner D, Hawes R, Schwaitzberg S, Kochman M, Swanström L (2011) The second SAGES/ASGE white paper on natural orifice translumenal endoscopic surgery: 5 years of progress. Surg Endosc 25:2441–2448PubMedCrossRef

Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117PubMedCrossRef

Kantsevoy SV, Jagannath S, Niiyama H, Scorpio D, Magee CA, Kalloo A (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292PubMedCrossRef

Park PO, Bergström M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 61(4):601–605PubMedCrossRef

Flora ED, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ (2008) A review of natural orifice translumenal endoscopic surgery (NOTES) for intraabdominal surgery. Ann Surg 247(4):583–602PubMedCrossRef

Swanström LL, Whiteford M, Kajanchee Y (2008) Developing essential tools to enable transgastric surgery. Surg Endosc 22(3):600–604PubMedCrossRef

Fritscher-Ravens A, Mosse CA, Ikeda K, Swain P (2006) Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance. Gastrointest Endosc 63(2):302–306PubMedCrossRef

Ryou M, Fong DG, Pai RD, Tavakkolizadeh A, Rattner DW, Thompson CC (2007) Dual-port distal pancreatectomy using a prototype endoscope and endoscopic stapler: a natural orifice transluminal endoscopic surgery (NOTES) survival study in a porcine model. Endoscopy 39(10):881–887PubMedCrossRef

10.

Fuchs KH, Breithaupt W, Schulz T, Ferencz S, Varga G, Weber G (2011) Transgastric small bowel resection and anastomosis—a survival study. Surg Endosc 24:601–609CrossRef

11.

Olsen MF, Josefson K, Dalenback J, Lundell L, Lonroth H (1997) Respiratory function after laparoscopic and open fundoplication. Eur J Surg 163(9):667–672PubMed

12.

Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124PubMedCrossRef

13.

Kehlet H, Whilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198PubMedCrossRef

14.

Deziel DJ, Milikan KW, Economou SG (1993) Complications of laparoscopic cholecystectomy: a national survey of 4292 hospitals and an analysis of 77,604 cases. Am J Surg 165:9–14PubMedCrossRef

15.

Härkki-Siren P, Sjöberg J, Kurki T (1999) Major complications of laparoscopy: a Finnish study. Obstet Gynecol 94(1):94–98PubMedCrossRef

16.

Fuchs KH, D-NOTES Working Group (2009) Summary of the D-NOTES meeting 2008. CHAZ 10(5):292–297

17.

Meining A, Kähler G, von Delius S, Buess G, Schneider A, Hochberger J, Wilhelm D, Kübler H, Kranzfelder M, Bajbouj M, Fuchs KH, Gillen S, Feussner H (2009) Natural orifices transluminal endoscopic surgery (NOTES) in Germany: summary of the working group reports of the “D-NOTES meeting 2009”. Z Gastroenterol 47(11):1160–1167PubMedCrossRef

18.

Kähler G, Bulian D, Collet P, Eickhoff A, Feussner H, Fritscher-Ravens A, Fuchs KH, Hochberger J, Kratt T, Meier PN, Meining A, Schäfer H (2010) Wilhelm D; Arbeitsgruppe NOTES (2011) Endoscopic surgery through natural orifices (NOTES) in Germany: status report. Z Gastroenterol 49(4):543–549CrossRef

19.

Meining A, Feussner H, Swain P, Yang GZ, Lehmann K, Zorron R, Meisner S, Ponsky J, Martiny H, Reddy N, Armengol-Miro JR, Fockens P, Fingerhut A (2010) Costamagna G (2011) Natural-orifice transluminal endoscopic surgery (NOTES) in Europe: summary of the working group reports of the Euro-NOTES meeting. Endoscopy 43(2):140–143CrossRef

20.

Fritscher-Ravens, Feussner H, Kähler G, Mathes K, Meining A, Hochberger J, Meier, P, von Delius S, von Renteln D, Wilhelm D, Burghardt J, Bernhardt J, Lamade W, Magdeburg R, Meier P, Vassiliou M, Fuchs KH, für die Arbeitsgruppe D-NOTES (2012) State of NOTES development in Germany: status report of the D-NOTES-Congress 2011. Z Gastroenterol 50(3):325–330

21.

Fuchs KH, Breithaupt W, Kuhl HJ, Schulz T, Dignaß A (2010) Experience with a training program for transgastric procedures in NOTES. Surg Endosc 24:601–609PubMedCrossRef

22.

Spaun GO, Zheung B, Swanström LL (2009) A multitasking platform for natural orifice transluminal endoscopic surgery (NOTES): a benchtop comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope. Surg Endosc 23:2720–2727PubMedCrossRef

23.

Narula VK, Hazey JW, Renton DB, Reavis KM, Paul CM, Hinshaw KE, Needleman BJ, Mikami DJ, Ellison EC, Melvon WS (2008) Transgastric instrumentation and bacterial contamination of the peritoneal cavity. Surg Endosc 22(3):605–611PubMedCrossRef

24.

Narula VK, Happel LC, Volt K, Bergmann S, Roland JC, Dettore R, Renton DB, Reavis KM, Needleman BJ, Mikami DJ, Ellison EC, Melvin WS, Hazey JW (2009) Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans. Surg Endosc 12(6):1331–1336CrossRef

25.

Nau P, Ellison EC, Muscarella P Jr, Mikami D, Narula VK, Needleman B, Melvon WS, Hazey JW (2011) A review of 130 humans enrolled in transgastric NOTES protocols at a single institution. Surg Endosc 25(4):1004–1011PubMedCrossRef

26.

Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endocopy 42:265–271CrossRef

27.

Zhou Ph, My Cai, Lq Yao, Ys Zhong, Ren Z, Xu MD, Chen WF, Qin XY (2011) Peroral endoscopic myotomy for esophageal achalasia: report of 42 cases. Zhonghua Wei Chang Wai Ke Ze Zhi 14(9):705–708

28.

von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, Much CC, Schachschal G, Mann O, Keller J, Fuchs KH, Rösch T (2012) Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 107:411–417CrossRef

29.

Ren Z, Zhong Y, Zhou P, Xu M, Cai M, Li L, Shi Q, Yao L (2012) Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc 26:3267–3272PubMedCrossRef

30.

Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T, Maselli R, Kudo SE (2012) Training in peroral endoscopic myotomy (POEM) for esophageal achalasia. Ther Clin Risk Manag 8:329–342PubMedCrossRef

31.

Dallemagne N, Perretta S, Allemann P, Donatelli G, Asakuma M, Mutter D, Marescaux J (2010) Transgastric cholecystectomy: from the laboratory to clinical implemention. World J Gastrointest Surg 2(6):187–192PubMedCrossRef

32.

Nikfarjam M, McGee MF, Trunzo JA, Onders RP, pearl JP, Poulose BK, Chak A, Ponsky JL, Marks JM (2010) Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and gastrotomy site selection by using a hybrid technique. Gastrointest Endosc 72:279–283

33.

Zheng Y, Wang D, Kong X, Chen D, Wu R, Yang l; Yu E, Zheng C, Li Z (2011) Initial experience from the transgastric endoscopic peritoneoscopy and biopsie: a stepwise approach from the laboratory to clinical application. J Gastroenterol Hepatol 26(5):888–893

34.

Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig K, Burghardt J, Büsing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252(2):263–270PubMedCrossRef

35.

Zorron R, Palanivelu C, Galvão Neto MP, Ramos A, Salinas G, Burghardt J, DeCarli L, Henrique Sousa L, Forgione A, Pugliese R, Branco AJ, Balashanmugan TS, Boza C, Corcione F, D′Avila Avila F, Arturo Gómez N, Galvão Ribeiro PA, Martins S, Filgueiras M, Gellert K, Wood Branco A, Kondo W, Inacio Sanseverino J, de Sousa JA, Saavedra L, Ramírez E, Campos J, Sivakumar K, Rajan PS, Jategaonkar PA, Ranagrajan M, Parthasarathi R, Senthilnathan P, Prasad M, Cuccurullo D, Müller V (2010) International multicenter trial on clinical natural orifice surgery—NOTES IMTN study: preliminary results of 362 patients. Surg Innov 17(2):142–158

36.

Zornig C, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmüller C, Mofid H (2011) NOTES cholecystectomy: matched pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 25(6):1822–1826PubMedCrossRef

37.

Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210PubMedCrossRef

38.

Lacy A, Adelsdorfer C (2011) Totally transrectal endoscopic total mesorectal excision TME. Colorectal Dis Suppl 7:43–46CrossRef

39.

Telem DA, Berger DL, Bordeianou LG, Rattner D, Sylla P (2012) Update on transanal NOTES for rectal cancer: transitioning to human trials. Minim Invasive Surg 2012:287613PubMed

40.

Fuchs KH, Breithaupt W, Varga G, Schulz T, Reinisch A, Josipovic N (2013) Transanal hybrid colon resection—from laparoscopy to NOTES. Surg Endosc 27:746–752

41.

Von Ott D (1902) Die Beleuchtung der Bauchhohle (Ventroskopie) als Methode bei vaginaler Coeliotomie. Abl Gynakol 231:817–823

42.

Decker A, Cherry TH (1944) Culdoscopy—a new method in the diagnosis of pelvic disease. Preliminary report. Am J Surg 64:40–44CrossRef

43.

Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P (2001) Operative culdolaparoscopy: a new approach combining operative culdoscopy and minilaparoscopy. J Am Assoc Gyn Laparosc 8:438–441CrossRef

44.

Gordts S, Puttemans P, Brosens I, Campo R (2005) Transvaginal laparoscopy. Best Pract Res Clin Obstet Gynaecol 19:757–767PubMedCrossRef

45.

Zornig C, Emmermann A, von Waldenfels HA, Felixmüller C (1994) Colpotomy for specimen removal in laparoscopic surgery. Chirurg 65:883–885PubMed

46.

Vereczkei A, Illenyi L, Arany A, Szabo Z, Toth L, Horvath OP (2003) Transvaginal extraction of laparoscopically removed spleen. Surg Endosc 17:157PubMedCrossRef

47.

Tsin DA, Sequeria RJ, Giannikas G (2003) Culdolaparoscopic cholecystectomy during vaginal hysterectomy. JSLS 7:171–172PubMed

48.

Zorron R, Filgueiras M, Maggioni LC, Pombo L, Lopes Carvalho G, Lacerda Oliveira A (2007) NOTES—transvaginal cholecystectomy: report of the first case. Surg Innov 14:279–283PubMedCrossRef

49.

Bessler M, Stevens PD, Milone L, Parikh M, Fowler D (2007) Transvaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery. Gastrointest Endosc 66:1243–1245PubMedCrossRef

50.

Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826PubMedCrossRef

51.

Zornig C, Mofid H, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C (2009) Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up. Endoscopy 41:391–394PubMedCrossRef

52.

Bernhardt J, Gerber B, Schober HC, Kahler G, Ludwig K (2008) NOTES—case report of a unidirectional flexible appendectomy. Int J Colorectal Dis 23:547–550PubMedCrossRef

53.

Roberts KE, Solomon D, Mirensky T, Silasi DA, Duffy AJ, Rutherford T, Longo WE, Bell RL (2012) Pure transvaginal appendectomy versus traditional laparoscopic appendectomy for acute appendicitis: a prospective cohort study. Ann Surg 255:266–269PubMedCrossRef

54.

Lacy AM, Delgado S, Rojas OA, Almenara R, Blasi A, Llach J (2008) MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 22(7):1717–1723PubMedCrossRef

55.

Linke GR, Tarantino I, Hoetzel R, Warschkow R, Lange J, Lachat R, Zerz A (2010) Transvaginal rigid-hybrid NOTES cholcystectomy: evaluation in routine clinical practice. Endoscopy 42(7):571–575PubMedCrossRef

56.

Tarantino L, Linke GR, Lange J, Siercks I, Warschkow R, Zerz A (2011) Transvaginal rigid-hybrid natural orifice transluminal endoscopic surgery technique for anterior resection treatment of diverticulitis: a feasibility study. Surg Endosc 25(9):3034–3042PubMedCrossRef

57.

Linke GR, Luz S, Janczak J, Zerz A, Schmied BM, Siercks I, Warschkow R, Beutner U, Taratino I (2013) Evaluation of sexual function in sexual active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients. Langenbecks Arch Surg 398:139–145PubMedCrossRef

58.

Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Gostout CJ (2007) Submucosal endoscopic esophageal myotomy: a novel experiment approach for the treatment of achalasia. Endoscopy 39:761–764PubMedCrossRef

59.

Swanström LL, Rieder E, Dunst CM (2011) A stepwise approach and early clinical experience in peroral andoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg 213(6):751–756PubMedCrossRef

60.

Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, Perri V (2012) Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis 44:827–832PubMedCrossRef

61.

Salinas G, Saavedra L, Agurto H, Quispe R, Ramirez E, Grande J, Tamayo J, Sanchez V, Malaga D, Marks JM (2010) Early experience in human transgastric and transvaginal endoscopic cholecystectomy. Surg Endosc 24:1092–1098PubMedCrossRef

62.

Dotai T, Coker AM, Antozzi L, Acosta G, Michelotti M, Bildzukewicz N, Sandler BJ, Jacobsen GR, Talamini MA, Horgan S (In press) Transgastric large-organ extraction: the initial human experience. Surg Endosc

63.

Perry KA, Shah N, Memark V, Nau P, Needleman BJ, Hazey JW (In press) Specialized instrumentation facilitates stable peritoneal access, gastric decompression, and visualization during transgastric endoscopic peritoneoscopy. Surg Innov

64.

Dallemagne B, Perretta S, Allemann P, Asakuma M, Marescaux J (2009) Transgastric hybrid cholecystectomy. Br J Surg 96(10):1162–1166PubMedCrossRef

65.

Buess G, Mentges B, Manncke K, Starlinger M (1992) Technique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 163:63–69PubMedCrossRef

66.

Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98(11):1635–1643PubMedCrossRef

67.

Wilhelm D, Meining A, von Delius S, Fiolka A, Can S, Hann von Weyhenn C, Schneider A, Feussner H (2007) An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy 39(5):401–406PubMedCrossRef

68.

Sylla P, Willingham FF, Sohn DK, Brugge WR, Rattner DW (2008) NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg 12(10):1717–1723PubMedCrossRef

69.

Denk PM, Swanström LL, Whiteford MH (2008) Transanal endoscopic microsurgical platform for natural orifice surgery. Gastrointest Endosc 68(5):954–959PubMedCrossRef

70.

Leroy J, Cahill RA, Peretta S, Forgione A, Dallemagne B, Marescaux J (2009) Natural orifice translumenal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model. Surg Endosc 23(1):24–30PubMedCrossRef

71.

Sylla P, Sohn DK, Cizginer S, Konuk Y, Turner BG, Gee DW, Willingham FF, Hsu M, Mino-Kenudson M, Brugge WR, Rattner DW (2010) Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. Surg Endosc 24(8):2022–2030PubMedCrossRef

72.

Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210PubMedCrossRef

73.

Lacy AM, Adelsdorfer C, Delgado S, Sylla P, Rattner D (2013) Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study. Surg Endosc 27:339–346PubMedCrossRef

74.

Zheng B, Rieder E, Cassera MA, Martinec DV, Lee G, Panton ON, Park A, Swanström LL (2012) Quantifying mentall workloads of surgeons performing natural orifice transluminal endoscopic surgery (NOTES) procedures. Surg Endosc 26(5):1352–1358PubMedCrossRef

75.

Neugebauer EA, Becker M, Buess GF, Cuschieri A, Dauben HP, Fingerhut A, Fuchs KH, Habermalz B, Lantsberg L, Morino M, Reiter-Theil S, Soskuty G, Wayand W, Welsch T (2010) EAES recommendations on methodology of innovation management in endoscopic surgery. Surg Endosc 24(7):1594–1615PubMedCrossRef

76.

Voermans RP, van Berge henegouwen MI, Bemelman WA, Fockens P (2011) Hybrid NOTES transgastric cholecystectomy with reliable gastric closure: an animal survival study. Surg Endosc 25:728–736

77.

Kirschniak A, Kratt T, Stüker D, Braun A, Schurr MO, Königsrainer A (2007) A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI-tract: first clinical experiences. Gastrointest Endosc 66:162–167PubMedCrossRef

Title: Euro-NOTES Status Paper: from the concept to clinical practice
Authors: K. H. Fuchs
A. Meining
D. von Renteln
G. Fernandez-Esparrach
W. Breithaupt
C. Zornig
A. Lacy
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2870-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Euro-NOTES Status Paper: from the concept to clinical practice

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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