Dray X, Marteau P
Conservatoire National des Arts et Métiers, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris-7, Paris, France.
Gastroenterol Clin Biol. 2009 Aug-Sep;33(8-9):758-66. doi: 10.1016/j.gcb.2009.07.010. Epub 2009 Aug 14.
Natural orifice translumenal endoscopic surgery (NOTES) allows access into the peritoneal cavity with a flexible endoscope, through the wall of the digestive or urogenital tracts. NOTES can be combined to laparoscopic surgery in so-called << hybrid >> techniques. In the absence of any incision of the abdominal wall, NOTES procedures provide perfect cosmetic results, with virtually no risk of parietal complications, and with decreased postoperative pain. NOTES could particularly benefit to overweight patients and to patients receiving intensive or palliative care. Most NOTES studies have been performed on animal models, with great interest for both transgastric and transpelvic approaches. Successful NOTES peritoneoscopy, hysterectomy, oophorectomy, tubal ligation, gastrojejunal anastomosis, cholecystectomy, splenectomy, nephrectomy, and abdominal-wall hernia repair have been described. In human studies, the transvaginal route is preferred. NOTES clinical research focuses on low-morbidity procedures, such as cholecystectomy, appendectomy, and peritoneoscopy. Indirect benefits are expected from this research, with possible technological innovations in the field of endoscopic instrumentation (including sutures, anastomosis, traction and triangulation). Overall, NOTES is believed to make evolve both interventional endoscopy and minimally invasive surgery.
经自然腔道内镜手术（NOTES）可通过柔性内镜经消化或泌尿生殖道壁进入腹腔。NOTES可与腹腔镜手术结合形成所谓的“杂交”技术。由于无需切开腹壁，NOTES手术具有完美的美容效果，几乎没有腹壁并发症风险，术后疼痛也有所减轻。NOTES对超重患者以及接受强化治疗或姑息治疗的患者可能特别有益。大多数NOTES研究是在动物模型上进行的，经胃和经盆腔入路都备受关注。已报道成功实施了NOTES腹腔镜检查、子宫切除术、卵巢切除术、输卵管结扎术、胃空肠吻合术、胆囊切除术、脾切除术、肾切除术以及腹壁疝修补术。在人体研究中，经阴道途径更为常用。NOTES临床研究主要集中在低发病率的手术，如胆囊切除术、阑尾切除术和腹腔镜检查。预计这项研究将带来间接益处，在内镜器械领域（包括缝合、吻合、牵引和三角定位）可能会有技术创新。总体而言，NOTES有望推动介入性内镜检查和微创手术的发展。
