Authors' objectives:

To assess the safety and efficacy of various intra-abdominal Natural Orifice Translumenal* Endoscopic Surgery (TM) (NOTES) procedures which do not cut the dermis, in comparison with traditional intra-abdominal surgery which cuts the dermis, through a systematic review of the literature.

Authors' results and conclusions: The evidence base for this review was very limited, as there were no comparative studies and all 22 included studies were conducted in animals, their purpose being to test the feasibility of NOTES. It was determined however, that at the present stage of development, NOTES does not appear to be as safe or effective as current intra-abdominal surgical techniques, and requires further development before it can be considered in a clinical setting. Although intra-abdominal access via oral, anal or urethral orifices could be achieved reliably in all cases, the evidence does not indicate the optimal access route and method. Viscerotomy closure could not be achieved reliably in all cases and risk of peritoneal infection has not been adequately minimised. Although the majority of interventions were able to be performed in animals using NOTES, a number of technical problems were encountered that will need to be resolved. The large number of abstracts relating to NOTES at the recent SAGES 2007 meeting suggests that this area of surgery is developing rapidly and accordingly, the evidence base will increase substantially. The review does indicate that it is feasible to use NOTES for some intra-abdominal surgical procedures, however it is too early to determine if these will be comparable to current procedures and if the advantages of using NOTES outweigh the disadvantages.

Authors' recommendations: On the basis of the evidence presented in this systematic review, the ASERNIP-S Review Group agreed on the following classifications concerning NOTES for intra-abdominal surgery: Evidence rating The available evidence was assessed as being poor. Safety At this point in time, NOTES for intra-abdominal surgery is less safe than laparoscopic and laparotomic alternatives. Efficacy Presently, NOTES for intra-abdominal surgery is currently less efficacious than laparoscopic and laparotomic alternatives.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s/publications.htm

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures -Surgical (ASERNIP-S)