Cirugía endoscópica transluminal por orificios naturales: NOTES

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Abstract

Se presenta una revisión actual, puesta al día, y punto de vista de los autores sobre un tema sumamente novedoso y atractivo, como es la Cirugía Endoscópica Transluminal por Orificios Naturales (NOTES: Natural Orifice Translumenal Endoscopic Surgery). La mayoría de los trabajos revisados se han realizado en animales de experimentación, pero la publicación de la colecistectomía por vía transvaginal, y la aparición de editoriales y artículos de revisión sobre el tema, nos llevan a realizar una serie de preguntas no resueltas actualmente sobre este tipo de cirugía, que representa un avance potencial para conseguir "una cirugía endoscópica sin cicatrices, sin infecciones, con mínimos requerimientos de anestesia y una inmediata recuperación".

Translated abstract

A current review and update of an exceedingly novel and appealing topic, namely natural orifice transluminal endoscopic surgery (NOTES), is discussed, as well as the authors' viewpoint thereon. Most reviewed studies were performed in laboratory animals, but reports on transvaginal cholecystectomy and the emergence of editorials and review articles on this topic pose a number of as yet unanswered questions on this type of surgery, which represents a potential advance towards "endoscopic surgery with no scars, no infection, minimal anesthesia requirements, and immediate recovery".

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Most cited references 88

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Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity.

Anthony N. Kalloo, Vikesh K. Singh, Sanjay B Jagannath … (2004)

A novel endoscopic peroral transgastric approach to the peritoneal cavity was tested in a porcine model in acute and long-term survival experiments. Transgastric peritoneoscopy was evaluated in 50-kg pigs. After upper endoscopy, the peritoneal cavity was accessed by needle-knife puncture of the gastric wall, followed by extension of the incision either with a pull-type sphincterotome or by balloon dilation. The peritoneal cavity was examined, and a liver biopsy specimen was obtained. The gastric wall incision was closed with clips. Twelve acute and 5 survival experiments were performed. Both techniques of gastric wall incision were without complication. The acute experiments demonstrated the technical feasibility of the approach. In the survival experiments, all pigs recovered and gained weight. The peroral transgastric approach to peritoneal cavity technically is feasible and has the potential to be an alternative to laparoscopy and laparotomy.

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ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005.

D Rattner, A Kalloo (2006)

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Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage.

Michel Kahaleh, A. de Boer, Naomi J Tokar … (2006)

Pancreatic pseudocysts are a complication in up to 20% of patients with pancreatitis. Endoscopic management of pseudocysts by a conventional transenteric technique, i. e. conventional transmural drainage (CTD), or by endoscopic ultrasound-guided drainage (EUD), is well described. Our aim was to prospectively compare the short-term and long-term results of CTD and EUD in the management of pseudocysts. A total of 99 consecutive patients underwent endoscopic management of pancreatic pseudocysts according to this predetermined treatment algorithm: patients with bulging lesions without obvious portal hypertension underwent CTD; all remaining patients underwent EUD. Patients were followed prospectively, with cross-sectional imaging during clinic visits. We compared short-term and long-term results (effectiveness and complications) at 1 and 6 months post procedure. 46 patients (37 men) underwent EUD and 53 patients (39 men) had CTD. The mean age of the entire group was 50 +/- 13 years. There were no significant differences between the two groups regarding short-term success (93% vs. 94%) or long-term success (84% vs. 91%); 68 of the 99 patients completed 6 months of follow-up. Complications occurred in 19% of EUD vs. 18% of CTD patients, and consisted of bleeding in three, infection of the collection in eight, stent migration into the pseudocyst in three, and pneumoperitoneum in five. All complications but one could be managed conservatively. No clear differences in efficacy or safety were observed between conventional and EUS-guided cystenterostomy. The choice of technique is likely best predicated by individual patient presentation and local expertise.

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Author and article information

Contributors

M. J. Varas Lorenzo: Role: ND

J. C. Espinós Pérez: Role: ND

M. Bardají Bofill: Role: ND

Journal

Journal ID (publisher): diges

Title: Revista Española de Enfermedades Digestivas

Abbreviated Title: Rev. esp. enferm. dig.

Publisher: Sociedad Española de Patología Digestiva (Madrid )

ISSN: 1130-0108

Publication date (Print): April 2009

Volume: 101

Issue: 4

Pages: 275-282

Affiliations

[1 ] Centro Médico TEKNON Spain

[2 ] Centro Médico TEKNON Spain

[3 ] Centro Médico TEKNON Spain

Article

Publisher ID: S1130-01082009000400006

DOI: 10.4321/s1130-01082009000400006

SO-VID: 793eac96-adc4-48b9-a2ba-817d28415a4f

License:

http://creativecommons.org/licenses/by/4.0/

History

Product

SciELO Spain

Self URI (journal page): http://scielo.isciii.es/scielo.php?script=sci_serial&pid=1130-0108&lng=en

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