World J Gastroenterol. 2011 Apr 7;17(13):1655-65. doi: 10.3748/wjg.v17.i13.1655.
Since the first description of the concept of natural orifice translumenal endoscopic surgery (NOTES), a substantial number of clinical NOTES reports have appeared in the literature. This editorial reviews the available human data addressing research questions originally proposed by the white paper, including determining the optimal method of access for NOTES, developing safe methods of lumenal closure, suturing and anastomotic devices, advanced multitasking platforms, addressing the risk of infection, managing complications, addressing challenges with visualization, and training for NOTES procedures. An analysis of the literature reveals that so far transvaginal access and closure appear to be the most feasible techniques for NOTES, with a limited, but growing transgastric, transrectal, and transesophageal NOTES experience in humans. The theoretically increased risk of infection as a result of NOTES procedures has not been substantiated in transvaginal and transgastric procedures so far. Development of suturing and anastomotic devices and advanced platforms for NOTES has progressed slowly, with limited clinical data on their use so far. Data on the optimal management and incidence of intraoperative complications remain sparse, although possible factors contributing to complications are discussed. Finally, this editorial discusses the likely direction of future NOTES development and its possible role in clinical practice.
自首次描述自然腔道内镜外科（NOTES）的概念以来，大量临床NOTES 报告已经出现在文献中。本社论回顾了现有的人类数据，这些数据涉及最初由白皮书提出的研究问题，包括确定 NOTES 的最佳进入方法、开发安全的腔道闭合方法、缝合和吻合设备、先进的多任务平台、解决感染风险、处理并发症、解决可视化挑战以及 NOTES 手术的培训。对文献的分析表明，迄今为止，经阴道进入和闭合似乎是 NOTES 最可行的技术，经阴道和经胃 NOTES 的经验有限，但正在增加，经直肠和经食管 NOTES 经验在人类中也在增加。由于 NOTES 手术而导致的理论上增加的感染风险，迄今为止在经阴道和经胃手术中尚未得到证实。缝合和吻合设备以及 NOTES 先进平台的开发进展缓慢，到目前为止，关于它们使用的数据有限。关于最佳管理和术中并发症发生率的数据仍然很少，但讨论了可能导致并发症的因素。最后，本社论讨论了未来 NOTES 发展的可能方向及其在临床实践中的可能作用。
