Natural Orifice Surgery (NOS), often referred to as Natural Orifice Transluminal Endoscopic Surgery (NOTES), is an innovative surgical approach that involves accessing the abdominal or thoracic cavity through natural body orifices such as the mouth, anus, vagina, or urethra, rather than making external incisions. This technique aims to minimize the invasiveness of surgery by reducing or eliminating surgical scars, decreasing postoperative pain, speeding up recovery, and potentially reducing complications associated with abdominal incisions like infections and hernias.
Indications:
Cholecystectomy (Gallbladder Removal): One of the most widely performed procedures using NOTES, primarily through transvaginal or transgastric approaches.
Appendectomy: Removal of the appendix through natural orifices like the mouth or vagina.
Gynecological Procedures: Including hysterectomy, removal of uterine fibroids, or tubal ligation, often via the vaginal route.
Gastrointestinal Surgeries: Such as the treatment of gastrointestinal tumors or staging by accessing through the stomach or rectum.
Exploratory Surgery: For diagnostic purposes, like examining the abdominal or thoracic cavity for various conditions.
Oncology: In rare cases for colorectal cancer or splenectomy in adult surgical oncology, although more research is needed for widespread application.
Techniques:
Transgastric Approach: An endoscope is passed through the mouth into the stomach, where an incision is made in the stomach wall to enter the peritoneal cavity. This method is particularly used for upper abdominal surgeries like cholecystectomy.
Transvaginal Approach: Instruments are inserted through the vagina to reach the peritoneal cavity, often used for pelvic surgeries or gallbladder removal. This is considered less technically challenging compared to transgastric due to fewer concerns over leakage and fistula formation.
Transrectal or Transanal: Used for colorectal surgeries where the colon or rectum serves as the access route.
Hybrid Techniques: Combining NOTES with laparoscopic assistance, where small incisions might be used for either visualization or additional manipulation tools, enhancing the feasibility of certain procedures.
Closure Techniques: Ensuring secure closure of the entry site (like the stomach or vagina) is crucial, often involving endoscopic clips, sutures, or specialized closure devices to prevent leaks or infections.
Instrumentation: Specialized flexible endoscopes and endoscopic tools are used, which must be adaptable for the unique challenges of operating through natural orifices.
NOTES procedures are still in the developmental phase, with ongoing research to refine techniques, improve instruments, and establish reliable closure methods. The safety and efficacy of these procedures continue to be evaluated through clinical trials and animal models to expand their applicability in human surgery.