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Natural Orifice Translumenal Endoscopic Surgery (NOTES) is a new form of minimally invasive surgery which eliminates traditional skin incisions by accessing internal body cavities through natural orifices such as the mouth. NOTES represents a radical breakthrough in less invasive surgery. By eliminating skin incisions patients have dramatically reduced post operative pain, less scarring, fewer potential complications, and are able to return to most normal activities in a fraction of the time in comparison to laparoscopic surgery.
NOTES was originally pioneered and studied by the Apollo Group (a group of world renowned gastroenterologists and surgeons), and in the past few years it has gained significant interest in thought leading institutions around the world. Today research is being conducted in the U.S., South America, Europe and Asia. Thought leading physicians from Mayo Clinic, Johns Hopkins, Stanford, Medical University South Carolina, Cleveland Clinic, Columbia, Ohio State Medical Center and many others are conducting research and performing the first NOTES procedures. At present approximately 200 NOTES procedures have been performed throughout the world.
Natural Orifice Translumenal Endoscopic Surgery (NOTES) can be further defined as Translumenal surgery (TS) and Endolumenal surgery (ES). Translumenal surgical procedures are performed through a natural orifice such as the mouth and involve passing a scope through the wall of the stomach, GI tract, or vagina to gain access to internal organs. In gallbladder surgery as an example the scope and surgical instruments would be passed down the mouth, and through a small incision in the stomach wall. The gallbladder would be then removed though the mouth without skin incisions. Endoluminal surgical incisions are procedures conducted exclusively within the lumen of the GI tract or internal organs. Examples of these procedures would be excision of superficial lesions, mucosal resections and new and evolving obesity procedures.
Many experts believe this major paradigm shift in surgery will forever change surgery as it has been performed historically. Today, basic science research is being conducted to fully answer questions around post operative infection rates compared to traditional and laparoscopic surgery, safe closure techniques of internal organs, and effective surgical technique. Additionally, leading surgical researchers are working closely with innovative device companies such as Apollo Endosurgery, Inc. based in Austin, TX to develop revolutionary new devices to enable these new less invasive approaches to surgery. Leading surgical societies such as the American College of Surgeons, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and the American Society of Metabolic and Bariatric Surgeons (ASMBS), are sponsoring research to responsibly advance less invasive surgical techniques.
Surgical patients of tomorrow will have less invasive, less painful surgical options available to them as this exciting movement progresses. Some experts predict that as high as 50% of general surgery procedures could be done as NOTES procedures in the future.
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