NOTES: Neue Impulse aus Forschung und Entwicklung

Zusammenfassung

Transluminale endoskopische Chirurgie über natürliche Körperöffnungen (NOTES) ist ein intensiv diskutiertes Thema heutzutage. Die kontroverse Debatte hierzu führt von euphorischen Visionen bis zur kompletten Ablehnung und ein technologischer Durchbruch ist weiter weg von der Realität als erwartet. Dieser Artikel gibt einen Überblick über den aktuellen Stand der Technik entstehend aus einer gründlichen Literaturrecherche einschließlich der persönlichen Erfahrungen. Die technologischen Barrieren die zurzeit eine klinische Anwendung hindern, wie es durch die NOSCAR-Gruppe definiert wurde, werden im Detail behandelt. Mit der Ausnahme des Eintritts durch die Vagina ist bis heute kein transluminaler Zugang klinisch reif. Die meisten Hindernisse sind nur eine Frage der weiteren Fortschritte, die in der Medizintechnik notwendig sind. Allerdings ist eine enge Zusammenarbeit zwischen Ingenieuren und Chirurgen essenziell für die Lösung der bestehenden Probleme. Derzeit verfügbare Werkzeuge und Techniken für NOTES befinden sich noch in frühen Entwicklungsstadien, allerdings weltweite Aktivitäten in Forschung und Entwicklung führen zu viel versprechenden Lösungen. Ob „reine NOTES” oder nur Hybride-Verfahren, Chirurgie wird einen weiteren Schritt nach vorn in Richtung der minimalinvasiven Disziplin gehen. 

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) is an intensely discussed topic today. The controversial debate on this leads from euphoric visions to complete refusal and a technological breakthrough is far away from reality than expected. This paper gives a review of the current state of the art emerging from a thorough literature research, including personal experiences. The technological barriers currently impeding the clinical use as defined by the NOSCAR group are dealt with in detail. No natural orifice entering technique is already clinically mature except the vaginal access. Most of the obstacles are just a matter of further progress required in medical engineering. However, a close cooperation between engineers and surgeons is essential for solving the existing problems. Currently available tools and techniques for NOTES are still in early stages of development, but world wide activities in research and development lead to very promising solutions. Whether “pure NOTES” or hybrid procedures only, surgery will take another step forwards towards a less invasive discipline. 

Schlüsselwörter

NOTES - transluminale Chirurgie - Viszerosynthese - mechatronische Plattform - räumliche Orientierung und Navigation

Key words

NOTES - transluminal surgery - viscerosynthesis - mechatronic platform - spatial orientation and navigation

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