Single-Incision and Natural Orifice Translumenal Endoscopic Surgery in Switzerland

• Published in: World journal of surgery Vol. 41; no. 2; pp. 449 - 456
• Main Authors: Steinemann, Daniel C., Zerz, Andreas, Adamina, Michel, Brunner, Walter, Keerl, Andreas, Nocito, Antonio, Scheiwiller, Andreas, Spalinger, Rene, Vorburger, Stephan A., Lamm, Sebastian H.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2017; Springer Nature B.V
• Subjects: Abdominal Surgery; Cardiac Surgery; Conventional Laparoscopic Cholecystectomy; Conventional Laparoscopy; Conversion to Open Surgery - statistics & numerical data; Female; General Surgery; German Registry; Humans; Intraoperative Complications - epidemiology; Laparoscopy - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Natural Orifice Endoscopic Surgery - statistics & numerical data; Natural Orifice Specimen Extraction; Natural Orifice Translumenal Endoscopic Surgery; Original Scientific Report; Postoperative Complications - epidemiology; Registries; Surgery; Surgical Procedures, Operative - methods; Surgical Procedures, Operative - statistics & numerical data; Switzerland - epidemiology; Thoracic Surgery; Vascular Surgery; Conventional Laparoscopy; Natural Orifice Specimen Extraction; German Registry; Natural Orifice Translumenal Endoscopic Surgery; Conventional Laparoscopic Cholecystectomy
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-016-3723-7

Background Single-incision laparoscopy (SIL) and natural orifice translumenal endoscopic surgery (NOTES) aim at reducing surgical access trauma. To monitor the introduction of emerging technologies, the Swiss Association for Laparo- and Thoracoscopic Surgeons launched a database in 2010. The current status of SIL and NOTES in Switzerland is reported, and the techniques are compared. Methods The number and type of procedures, surgeon experience, their impressions of performance, conversion, and complications between 2010 and 2015 are described. A survey was used to acquire additional data not included in the registry. Results Nine centers included 650 procedures. Cholecystectomy (55 %) and sigmoidectomy (26 %) were most prevalent in both techniques. The number of active centers declined from 9 to 2 during the study period. The frequencies of taught procedures were 4 and 43 % for SIL and NOTES ( p  < 0.001), and surgeon self-estimated impression of performance was perfect in 50 and 89 %, respectively ( p  < 0.0001). Conversions in total were 3.6 and 5.7 %, respectively, and 1.1 % to open for both techniques. Morbidity was 5 % in SIL and 2.7 % in NOTES, with 0.8 % access-related complications in NOTES and none in SIL ( p  = 0.29). Of laparoscopic cholecystectomy, sigmoidectomy, and right hemicolectomy, 11.4 and 15.6 % of cases were operated using SIL or NOTES, respectively ( p  < 0.0001). Conclusions Although in selected specialized centers, a considerable proportion of patients were treated using novel techniques, a fading interest of the surgical community in SIL and NOTES was observed. The proportion of SIL and NOTES procedures taught is insufficient and calls for improvement.