here - Malaysian Society of Colorectal Surgeons

H O W I D O I T ( 1 )NOTESChun Ho-KyungDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaNatural orifice transluminal endoscopic surgery (NOTES) refers to the method of accessing theabdominal cavity through a natural orifice under endoscopic visualization. Furthermore, it is the newesttechnique emerging in the field of surgery. Work on animal models has been progressing for many years,and has now culminated in the successful endoscopic surgery in human subjects. Most NOTESresearchers have favored transgastric and transvaginal approaches to abdominal access.In our institute, we first performed NOTES (transcolonic cholecystectomy) in pigs during the latter partof 2007 with the Korean NOTES Study Group. Since then, we have had experience in 20 porcine modelsand 2 human cases. During the experimental periods, we performed cholecystectomy or oophorectomywith several approaches such as transgastric, transvaginal and transcolonic routes. To the overcome thelimits of NOTES, we devised simple magnetic coupled traction (SMCT) for transvaginal endoscopiccholecystectomies. SMCT was composed of internal magnets and external handheld magnets.Internal magnets were fixed to endoscopic clips on the gall bladder (GB) and external handheld magnetssupplied the traction GB to an abdominal wall. It provided a fine operation field through offeringexcellent fundus retraction.As development of technique, transgastric sigmoidectomy was performed with colon mobilization undersigmoidoscopy assistance. Recently, we performed the transvaginal approach for endoscopicappendectomy in humans before transvaginal hysterectomy.There were some reports for development of NOTES in animal models and human. However, as a newestsurgical technique, NOTES are still in early stages of development and more robust technologies will beneeded to achieve reliable closure and overcome technical challenges. Furthermore, well-managed humanstudies need to be conducted to determine the safety and efficacy of NOTES in a clinical setting.19