Comparison of Advantages and Disadvantages between SILS and NOTES

Abstract

Minimal access surgery is the gold standard for several abdominopelvic procedures in the present era. The prime advantage withminimal access surgery is the minimal surgical trauma in comparison to the conventional surgery. The other advantages of laparoscopylike less operative time, less pain, early recovery and return to work and above all better cosmetics have been well proven.�Change isconstant in life,� SILS and NOTES are the two newly emerging novel techniques in laparoscopy. SILS is a new advancement inlaparoscopy, where the whole surgery is conducted through a single umbilical incision whereas NOTES is totally incisionless. In realsense, the incision in NOTES is not externally visible because of the natural orifices like oral cavity, vagina, urethra and anus that areused as entry sites. SILS have the advantages of better cosmetics, less blood loss, faster recovery, less complications, early return towork, versatility, better patient acceptance and easy tissue retrieval, etc. The critics are high cost, need of high expertise and morechances of port site hernia and infection. Similarly, NOTES has its edges over traditional laparoscopy surgery with the advantages ofhighest cosmetic value (no visible scar), less pain, requirement of less immunosuppressant and less anesthesia, faster recovery, andno external wound complications (hernia, hematoma and abscess). But it has also its own critics like questionable safety, unproven dataabout complications, requirement of high expertise, low patient acceptance, requirement of advanced endoscopic instruments, difficultyin closing internal wounds, intraperitoneal infection, gastrointestinal fistula and high cost. Poor acceptance is a major concern forNOTES.Aims: To explore the positive and negative aspects of above two procedures in order to find out the better option.