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Endoluminal Methods for Gastrotomy Closure in Natural Orifice TransEnteric Surgery (NOTES)

Minimally Invasive Surgery Division, Legacy Health System, Portland, Oregon, London, UK

Paul Swain, MD

Department of Surgical Oncology and Technology, St. Mary's Hospital, London, UK

Lee L. Swanstrom, MD

Minimally Invasive Surgery Division, Legacy Health System, Portland, Oregon, London, UK; Minimally Invasive Surgery Division 1040 NW 22nd Avenue, Suite 560, Portland, OR 97210 lswanstrom{at}aol.com

Natural orifice transenteric surgery (NOTES) is a new and rapidly evolving concept for intra-abdominal operations that offers the potential for a revolutionary advance in patient care. Conceptually, operations that currently require an open or laparoscopic approach could be performed without incisions in the abdomen, with their concomitant pain and scarring. A recent consensus statement by a joint group of gastrointestinal surgeons and gastroenterologists has identified several technical and technologic hurdles that would need to be overcome before NOTES becomes a clinical reality. One of the most significant requirements identified is the need for a very secure closure of the gastrotomy site that is required for scope passage and specimen removal. Although a rapidly expanding variety of transgastric procedures has been reported, only a few reports address the basic problem of gastrotomy closure. Availability of a safe and simple gastrotomy closure device, however, will be essential for the widespread adoption of the new field of NOTES. Unless new safe and simple devices for endoscopic gastrotomy closure are available and have proven efficacy, NOTES will remain in the hands of a few specialists at centers of excellence because the risk of complications due to insufficient gastrotomy closure will not be acceptable for the surgeon and gastroenterologist in general practice. In this article, we describe three new devices in development or newly on the market that are targeted to advance the safe endoscopic closure of gastrotomy from NOTES.

Key Words: natural orifice transenteric surgery • intra-abdominal • gastronomy

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Surgical Innovation, Vol. 13, No. 1, 23-30 (2006)
DOI: 10.1177/155335060601300105


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (62) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sclabas, G. M. Articles by Swanstrom, L. L. Search for Related Content PubMed PubMed Citation Articles by Sclabas, G. M. Articles by Swanstrom, L. L. Pubmed/NCBI databases Medline Plus Health Information Endoscopy Social Bookmarking                         What's this?