Natural orifice translumenal endoscopic surgery (NOTES) has been receiving increasing attention and is being considered as a potential alternative to laparascopic surgery; but it will be a long time before NOTES comes to pediatrics. Initial studies for several indications have been published in the last few years and this experience has recently been reviewed (Gastroenterology 2012; 142: 704-10).
Potential operations include the following:
- Cholecystectomy. This has been accomplished transgastric and transvaginally. One multicenter study published experience with 362 transgastric cases and another with 551 transvaginal cases.
- Thyroidectomy via a translingual approach.
- Esophageal myotomy via a transesophageal approach.
- Appendectomy via a transvaginal approach.
- Rectal cancer resection via a transrectal approach.
Thus far, complications have been low & no deaths; only infrequently has a laparascopic or open procedure been needed to salvage the operation. The main limitation to further use of NOTES has been adequate instrumentation and a critical mass of investigators to explore this technique. As expertise develops in this area, a much larger number of procedures will be undertaken. In many ways, NOTES is akin to laparascopy in its early days. Potential advantages of decreased pain and faster recovery are the motivation to continue to work on NOTES.