Marescaux Jacques, Dallemagne Bernard, Perretta Silvana, Wattiez Arnaud, Mutter Didier, Coumaros Dimitri
Institut de Recherche contre les Cancers de l'Appareil Digestif-European Institute of TeleSurgery, University Louis Pasteur, 1 place de l'Hôpital-Hôpitaux Universitaires, 67091 Strasbourg Cedex, France.
Arch Surg. 2007 Sep;142(9):823-6; discussion 826-7. doi: 10.1001/archsurg.142.9.823.
Natural orifice transluminal endoscopic surgery (NOTES) provides the potential for performance of incisionless operations. This would break the physical barrier between bodily trauma and surgery, representing an epical revolution in surgery. Our group at IRCAD-EITS (Institut de Recherche contre les Cancers de l'Appareil Digestif [Institute of Digestive Cancer Research]-European Institute of TeleSurgery) has been actively involved in the development of NOTES since 2004 with a dedicated project created to develop feasibility and survival studies and new endoscopic technology.
NOTES cholecystectomy in a woman via a transvaginal approach.
University hospital. Patient The patient was a 30-year-old woman with symptomatic cholelithiasis.
The procedure was carried out by a multidisciplinary team using a standard double-channel flexible videogastroscope and standard endoscopic instruments. The placement of a 2-mm needle port, mandatory to insufflate carbon dioxide and to monitor the pneumoperitoneum, was helpful for further retraction of the gallbladder. At no stage of the procedure was there need for laparoscopic assistance. All of the principles of cholecystectomy were strictly adhered to.
The postoperative course was uneventful. The patient had no postoperative pain and no scars, and was discharged on the second postoperative day.
Transluminal surgery is feasible and safe. NOTES, a radical shift in the practice and philosophy of interventional treatment, is becoming established and is enormously advantageous to the patient. With its invisible mending and tremendous potential, NOTES might be the next surgical evolution.
经自然腔道内镜手术（NOTES）为开展无切口手术提供了可能。这将打破身体创伤与手术之间的物理屏障，代表着外科手术的一场重大变革。自2004年以来，我们在IRCAD-EITS（消化器官癌症研究所 - 欧洲远程外科学研究所）的团队一直积极参与NOTES的开发，设立了一个专门项目来开展可行性和生存研究以及新的内镜技术。
经阴道途径对一名女性实施NOTES胆囊切除术。
大学医院。患者为一名30岁有症状胆结石的女性。
该手术由一个多学科团队使用标准的双通道柔性电子胃镜和标准的内镜器械进行。放置一个2毫米的穿刺端口，用于注入二氧化碳和监测气腹，这有助于进一步牵拉胆囊。在手术的任何阶段都无需腹腔镜辅助。严格遵循了胆囊切除术的所有原则。
术后过程顺利。患者术后无疼痛且无疤痕，术后第二天出院。
经腔手术是可行且安全的。NOTES作为介入治疗实践和理念的根本性转变，正在逐渐确立，对患者极为有利。凭借其无痕修复和巨大潜力，NOTES可能是外科手术的下一次变革。
