NOTES: Cholecystectomy (European Experience)

Abstract

Recent decades have seen remarkable progress in medicine as minimally invasive procedures have replaced radical surgical resections. Natural orifice translumenal endoscopic surgery (NOTES) is an evolving minimally invasive technique that has the potential to break the physical barrier between incisions and surgery. The present-day concept of NOTES was articulated by Kalloo et al. in 2004, who challenged surgeons and endoscopists to focus research on finding the best translumenal endoscopic access to the peritoneal cavity, with the utmost attention to safety, including the reliable closure of the entry point. The justifications for this technique are as follows: the reduction or absence of postoperative pain; the ease of access to some organs; the absence of trauma to the abdominal wall; ideal cosmetic results; and the psychological advantages of eliminating the trauma caused by transabdominal surgery. Both transvaginal and transgastric cholecystectomies have been translated from research into clinical applications, attracting an explosion of interest. Since the first report from Marescaux et al. and Bessler et al. in 2007, over 500 NOTES cholecystectomies have been reported in Europe, mostly using a hybrid approach between NOTES and laparoscopy. With the goal of tracking the evolution of new techniques, a global European NOTES activity registry, the Euro-NOTES Registry (www.euronotes.world.it), was created among ten centers. An independent nationwide German registry was also established as an outcome database to allow the monitoring and safe introduction of NOTES. Both registries invite surgeons who performed NOTES procedures to voluntarily contribute. Despite the fact that NOTES has just recently been introduced, the technique has already gained considerable clinical application in Europe, and it appears to be well accepted by patients. According to the registries, cholecystectomies account for 89 % of all NOTES procedures in Europe. NOTES cholecystectomies have been described in Europe using the transvaginal approach with rigid in-line instruments, and through both the transvaginal and transgastric approaches with a flexible platform.