REVIEWS   

Minerva Chirurgica 2008 October;63(5):385-8

Copyright © 2008 EDIZIONI MINERVA MEDICA

language: English

A colorectal surgeons viewpoint on natural orifice translumenal endoscopic surgery

Whiteford M. H. ^{1, 2}, Spaun G. O. ²

¹ Oregon Health and Science University Portland, OR, USA 2 Gastrointestinal and Minimally Invasive Surgery Program Legacy Health System, Portland, OR, USA

Natural orifice translumenal endoscopic surgery (NOTES) represents a burgeoning but still largely experimental field. Most NOTES reseachers have favored transgastric and transvaginal approaches to abdominal access. For surgeries involving the upper abdominal organs, tranavaginal and transanal approachs promise to provide a more direct route in contrast to the often cumbersome retroflexion typically required with the transgastric approach. The potential disadvantages of the transanal route are also significant and include issues of sterility, the risk of inadvertent trauma to adjacent organs during transmural puncture, and the risk of colonic wall shearing. This article reviews early development of NOTES, the evolution of transanal access to the peritoneal cavity, highlights the various techniques that have been used for transanal access, and discusses the relative advantages and disadvantages of this approach.