Sclabas Guido M, Swain Paul, Swanstrom Lee L
Minimally Invasive Surgery Division, Legacy Health System, Portland, Oregon 97210, USA.
Surg Innov. 2006 Mar;13(1):23-30. doi: 10.1177/155335060601300105.
Natural orifice transenteric surgery (NOTES) is a new and rapidly evolving concept for intra-abdominal operations that offers the potential for a revolutionary advance in patient care. Conceptually, operations that currently require an open or laparoscopic approach could be performed without incisions in the abdomen, with their concomitant pain and scarring. A recent consensus statement by a joint group of gastrointestinal surgeons and gastroenterologists has identified several technical and technologic hurdles that would need to be overcome before NOTES becomes a clinical reality. One of the most significant requirements identified is the need for a very secure closure of the gastrotomy site that is required for scope passage and specimen removal. Although a rapidly expanding variety of transgastric procedures has been reported, only a few reports address the basic problem of gastrotomy closure. Availability of a safe and simple gastrotomy closure device, however, will be essential for the widespread adoption of the new field of NOTES. Unless new safe and simple devices for endoscopic gastrotomy closure are available and have proven efficacy, NOTES will remain in the hands of a few specialists at centers of excellence because the risk of complications due to insufficient gastrotomy closure will not be acceptable for the surgeon and gastroenterologist in general practice. In this article, we describe three new devices in development or newly on the market that are targeted to advance the safe endoscopic closure of gastrotomy from NOTES.
经自然腔道内镜手术（NOTES）是一种用于腹腔内手术的全新且快速发展的概念，有望给患者护理带来革命性的进步。从概念上讲，目前需要开腹或腹腔镜手术的操作，将来可以在不切开腹部的情况下进行，从而避免随之而来的疼痛和疤痕。胃肠外科医生和胃肠病学家联合小组最近发布的一份共识声明指出，在NOTES成为临床现实之前，有几个技术和工艺障碍需要克服。其中最关键的要求之一是，为了通过内镜和取出标本，需要非常安全地封闭胃切开部位。尽管已经报道了越来越多的经胃手术，但只有少数报告涉及胃切开闭合的基本问题。然而，对于NOTES这一新领域的广泛应用而言，拥有一种安全、简单的胃切开闭合装置至关重要。除非有新的安全、简单的内镜胃切开闭合装置可供使用且已证明其疗效，否则NOTES仍将掌握在少数卓越中心的专家手中，因为对于普通外科医生和胃肠病学家来说，胃切开闭合不充分导致并发症的风险是不可接受的。在本文中，我们将介绍三种正在研发或新上市的装置，这些装置旨在推动NOTES中胃切开的安全内镜闭合技术发展。
