NOTES, MANOS, SILS and other new laparoendoscopic techniques

Abstract

A new way of opening a body cavity can be a revolution in surgery. In 1980s, laparoscopy changed how surgeons had been working for years. Natural orifice translumenal endoscopic surgery (NOTES), minilaparoscopy-assisted natural orifice surgery (MANOS), single incision laparoscopic surgery (SILS) and other new techniques are the new paradigm in our way of operating in the 21(st) century. The development of these techniques began in the late 90s but they have not had enough impact to develop and evolve. Parallels between the first years of laparoscopy and NOTES can be made. Working for an invisible surgery, not only for cosmesis but for a less invasive surgery, is the target of NOTES, MANOS and SILS performed by surgeons and endoscopists over the last 10 years. The future flexible endoscopic platforms and the fusion between laparoscopic instruments and devices and robotic surgery will be a great advance for "scarless surgery".

Keywords: Endoscopy; Flexible endoscopy; Laparoscopy; Minilaparoscopy-assisted natural orifice surgery; Natural orifice translumenal endoscopic surgery; Single incision laparoscopic surgery.

Figure 1

Distribution of the entry-ports by approach to perform cholecystectomy. CL: Conventional laparoscopy. CML: Conventional minilaparoscopy; SIS: Single incision surgery; TV: Flexible or rigid transvaginal endoscopy; TU: Transumbilical flexible endoscopy; FSIS: Flexible single incision surgery.

Figure 2

Cholecystectomy by flexible single incision surgery. Umbilical single incision and direct approach with the flexible endoscope without complementary device. Two parallel 5 mm ports are needed to perform a secure procedure.