Subscribe to RSS
DOI: 10.1055/s-0028-1098689
© Georg Thieme Verlag Stuttgart ˙ New York
NOTES: Neue Impulse aus Forschung und Entwicklung
NOTES: Impact from Research and DevelopmentPublication History
Publication Date:
29 December 2008 (online)
![](https://www.thieme-connect.de/media/endoheute/200804/lookinside/thumbnails/10.1055-s-0028-1098689-1.jpg)
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
Literatur
- 1 ASGE / SAGES Working Group on Natural Orifice Transluminal Endoscopic Surgery . White Paper. Gastrointest Endosc. 2006; 63 199-203
- 2 Gettman M T, Blute M L. Transvesical peritoneoscopy: initial clinical evaluation of the bladder as a portal for natural orifice translumenal endoscopic surgery. Mayo Clin Proc. 2007; 82 843-845
- 3 Lima E, Henriques-Coelho T, Roland C et al. Transvesical thoracoscopy: A natural orifice translumenal approach for thoracic surgery. Surg Endosc. 2007; 21 854-858
- 4 Fong D G, Pai R D, Thompson C C. Transcolonic endoscopic abdominal exploration: a NOTES survival study in a porcine model. Gastrointest Endosc. 2007; 65 312-318
- 5 Pham B V, Raju G S, Ahmed I et al. Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model. Gastrointest Endosc. 2006; 64 113-119
- 6 Can S, Fiolka A, Wilhelm D et al. Set of instruments for innovative, safe and sterile sigmoid access for natural-orifice transluminal endoscopic surgery / Ein Instrumentenset für den innovativen, sicheren und sterilen sigmoidalen Zugang für die transluminale endoskopische Chirurgie über natürliche Körperöffnungen. Biomedizinische Technik. 2008; 53 185-189
- 7 Wilhelm D, Meining A, von Delius S et al. An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy. 2007; 39 401-406
- 8 Sumiyama K, Gostout C J, Rajan E et al. Endoscopic full-thickness closure of large gastric perforations by use of tissue anchors. Gastrointest Endosc. 2007; 65 134-139
- 9 McGee M F, Marks J M, Onders R P et al. Complete Endoscopic Closure of Gastrotomy After Natural Orifice Translumenal Endoscopic Surgery Using the NDO Plicator. Surgical Endoscopy. 2008; 22 214-220
- 10 Swanstrom L L, Whiteford M, Khajanchee V. Developing essential tools to enable transgastric surgery. Surg Endosc. 2008; 22 600-604
- 11 Hausmann U, Feussner H, Ahrens P et al. Endoluminal endosurgery; rivet application in flexible endoscopy. Gastrointest Endosc. 2006; 64 101-103
- 12 Chiu P W, Lau J Y, Ng E K et al. Closure of a gastrotomy after transgastric tubal ligation by using the Eagle Claw VII: a survival experiment in a porcine model (with video). Gastrointest Endosc. 2008; , (in press)
- 13 Voermans R P, Worm A M, van Berge Henegouwen M I et al. In vitro comparison and evaluation of seven gastric closure modalities for natural orifice transluminal endoscpic surgery (NOTES). Endoscopy. 2008; 40 595-601
- 14 Kirschniak A, Kratt T, Stüker D et al. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc. 2007; 66 162-167
- 15 Magno P, Giday S A, Dray X et al. A new stapler based full thickness transgastric access closure: results from an animal pilot trial. Endoscopy. 2007; 39 876-880
- 16 Swanstrom L L, Kozarek R, Pasricha P J et al. Development of a new access device for transgastric surgery. J Gastrointest Surg. 2005; 9 1129-1136
- 17 Thompson C C, Ryou M, Rothstein R I et al. Stomach – direct drive endoscopic system for endoluminal and NOTES applications. The DAVE project. 2008
- 18 Can S, Fiolka A, Mayer H et al. The mechatronic support system “HVSPS” and the way to NOTES. MITAT. 2008; , (in press)
- 19 Herron D M, Marohn M A. A consensus document on robotic surgery. Surg Endosc. 2008; 22 313-325
- 20 Mayer H, Nagy I, Knoll A et al. Human Computer Interfaces of a System for Robotic Heart Surgery. Proceedings of the Second IASTED International Conference on Human-Computer Interaction. Chamonix, France; 2007: 31–36
- 21 Mayer H, Gomez F, Wierstra D et al. A System for Robotic Heart Surgery that Learns to Tie Knots Using Recurrent Neural Networks, Intelligent Robots and Systems. IEEE / RSJ International Conference on 2006: 543–548
- 22 Feuerstein M, Reichl T, Vogel J et al. Magneto-optic tracking of a flexible laparoscopic ultrasound transducer for laparoscope augmentation. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv. 2007; 10 (Pt 1) 458-466
- 23 Feussner H, Gillen S, Hagen M et al. Assessment of current gastrointestinal occlusion techniques for NOTES. Endoskopie heute. 2008; , (in press)
- 24 Vosburgh K G, Estépar R SJ. Natural Orifice Transluminal Endoscopic Surgery (NOTES): An opportunity for Augmented Reality. Stud Health Technol Inform. 2007; 125 485-490
- 25 Penne J, Höller K, Krüger S et al. NOTES3D: Endoscopes learn to see 3D; Basic Algorithms for a Novel Endoscope. In: Ranchor-das AH, Araújo H, Vitriá J, eds. VISAPP, Second International Conference on Computer Vision Theory and Applications (VISAPP Barcelona 8.–11.3.2007). Barcelona: Insticc Press; 2007: 134–139
- 26 Padoy N, Horn M, Feussner H et al. Recovery of surgical workflow: A model based approach. Int J CARS. 2007; 2 (Suppl) 479-482
- 27 Feussner H. The operating room of the future: A view from Europe. Sem Laparosc Surg. 2003; 10 149-156
- 28 Rassweiler J, Klein J, Teber D et al. Mechanical Simulators for Training for Laparoscopic Surgery in Urology. Journal of Endourology. 2007; 21 252-262
- 29 Sarker S K, Patel B. Simulation and surgical training. Intl J Clin Practice. 2007; 61 2120-2125
- 30 Gillen S, Meining A, Fiolka A et al. The “ELITE” model: Construct validation of a new training system for Natural Orifice Translumenal Endoscopic Surgery (NOTES). Endoscopy. 2008; , (in press)
- 31 Johnson E. Surgical simulators and simulated surgeons: Reconstituting medical practice and practitioners in simulations. Soc Stud Sci. 2007; 37 585-608
Prof. Dr.-Ing. A. Knoll
Robotics and Embedded Systems · Technische Universität München
Boltzmannstraße 3
85748 Garching bei München
Phone: +49 / 89 / 28 91 81 06
Fax: +49 / 89 / 28 91 81 07
Email: knoll@in.tum.de