Watson R R, Thompson C C
Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Minerva Gastroenterol Dietol. 2011 Jun;57(2):177-91.
Natural orifice transluminal endoscopic surgery (NOTES) has ushered in a new era in flexible endoscopy. Over the past decade, modest advances have been made in addressing the fundamental challenges of NOTES surgery including transluminal access and closure techniques, and advancement of NOTES-specific technology. Despite these encouraging initial efforts significant obstacles to widespread acceptance of NOTES as a surgical option persist. Moreover, due to the well-documented safety and efficacy of laparoscopic techniques, the question remains as to the best candidate NOTES procedure. Presently, interest has shifted from true NOTES to hybrid procedures and single incision laparoscopic surgery, due to the lure of more immediate success. Additionally, there is also a growing awareness of the potential applications of natural orifice surgery techniques to the present field of therapeutic endoscopy. Research into transluminal access and closure has born several techniques and devices that are now being explored in endoscopic procedures such as full-thickness resection, endoscopic myotomy, direct endoscopic pancreatic necrosectomy and bariatric endoscopy. Such NOTES "spin-off" procedures are expanding the armamentarium of today's therapeutic endoscopists, and a growing body of literature suggests that they will play a significant role in the evolution of therapeutic endoscopy in the future.
经自然腔道内镜手术（NOTES）开创了柔性内镜的新纪元。在过去十年中，NOTES手术在应对包括经腔道进入和闭合技术以及NOTES专用技术的发展等基本挑战方面取得了一定进展。尽管这些初步努力令人鼓舞，但NOTES作为一种手术选择被广泛接受仍存在重大障碍。此外，由于腹腔镜技术已被充分证明的安全性和有效性，关于最佳NOTES候选手术的问题依然存在。目前，由于更直接成功的诱惑，兴趣已从真正的NOTES转向了杂交手术和单切口腹腔镜手术。此外，人们也越来越意识到自然腔道手术技术在当前治疗性内镜领域的潜在应用。对经腔道进入和闭合的研究产生了几种技术和装置，目前正在诸如全层切除术、内镜下肌切开术、直接内镜下胰腺坏死组织清除术和减重内镜检查等内镜手术中进行探索。此类NOTES“衍生”手术正在扩充当今治疗性内镜医师的器械库，并且越来越多的文献表明它们将在未来治疗性内镜的发展中发挥重要作用。
