Developing essential tools to enable transgastric surgery

• Published in: Surgical endoscopy Vol. 22; no. 3; pp. 600 - 604
• Main Authors: Swanstrom, L. L., Whiteford, M., Khajanchee, Y.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.03.2008; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Biological and medical sciences; Endoscopy; Endoscopy, Digestive System - instrumentation; Endoscopy, Digestive System - trends; Endoscopy, Gastrointestinal - methods; Engineers; Equipment Design; Equipment Safety; Female; Fiber Optic Technology - instrumentation; Forecasting; Gallbladder; Gastroenterology; Gastroscopes; Gastroscopy - methods; General aspects; Gynecology; Hepatology; Humans; Intellectual property; Laparoscopy; Male; Medical equipment; Medical sciences; Medical technology; Medicine; Medicine & Public Health; Minimally Invasive Surgical Procedures - instrumentation; Proctology; Sensitivity and Specificity; Surgeons; Surgery; Surgical Instruments; Technology Assessment, Biomedical; Oregon; United States > US; NOTES; Innovation; Medical devices; New technology; Flexible endoscopy; Surgery; Medicine; Endoscopic surgery; Treatment; Device; Endoscopy; Medical devices, New technology
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-007-9632-y

Natural orifice transluminal endoscopic surgery (NOTES) is a largely theoretical but potentially exciting evolution of minimally invasive surgical care. Using technology borrowed from current diagnostic and therapeutic flexible endoscopy, the idea is to replicate current laparoscopic procedures in an “incisionless” manner. It is widely recognized that for NOTES to become a practical reality, many issues need to be resolved, both methodologic and political. One critical element of development will be the design of appropriate instrumentation for NOTES. This is currently happening and involves a complex collaboration between industry and clinicians both to adapt current equipment and to design and create new tools to enable the performance of transluminal procedures. This article describes the current process of such technology development as well as the resulting instrumentation that enables the performance of NOTES. The issues of access and platform stability, laparoscopic-like instruments, and secure tissue approximation are described, and the devices to solve these issues are detailed.