Techniques for endoluminal intestinal tract surgery

Abstract

SummaryEndoluminal surgery may be defined as procedures performed in a hollow organ using typical surgical techniques, such as dissection, suturing and stapling. By their nature, these procedures must be performed under endoscopic control. Applications of endoluminal surgery to the gastrointestinal tract should ideally be performed via natural orifices. Gastric endoluminal procedures, such as tissue resection by means of strip biopsy or polypectomy, are becoming increasingly common, especially in Japan. The laparoscopic transgastric approach has also been described recently. Endoluminal rectal surgery using retractors started many centuries ago. Complex surgical techniques under endoscopic vision can be performed by transanal endoscopic microsurgery (TEM). Today TEM is widely accepted, but not in every country. With the current impact of new technology, numerous potential endoluminal applications can be foreseen. Ongoing projects in endoluminal surgery include the treatment of bleeding ulcers of the gastrointestinal tract, antireflux techniques for gastro-oesophageal reflux disease (GERD) and the full-thickness resection of early gastrointestinal lesions. Compared with laparoscopic surgery, endoluminal surgery is a further important step in reducing the invasiveness of procedures. In combination with future endoscopic screening programmes for early tumours of the gastrointestinal tract, a revolution in the surgical treatment of these diseases can be foreseen.