Natural Orifice Transluminal Endoscopic Surgery
(NOTES)
Natural Orifice Trangastric Endoscopic Surgery is revolutionizing in the field of surgery. It includes Transgastric, Trans anal or Trans Vaginal access. Difficulties are due to flexibility of scopes, limited working accessories used for ERCP, working channel lying parallel and close to each other and change of visual image due to movement of accessories.
It is team work of advanced laparoscopic surgery and advanced endoscopic techniques.
Experience in animal lab
Trans gastric access of double channel endoscope to perform gall bladder in pigs. Difficulties mentioned above experienced but successfully performed five chocystectomies by transgastric approach. We felt the need to perform step by step in patients.
Trans umbilical access as a tool to learn NOTES
Placing double channel endoscope at the umbilicus but performing the entire procedure with endoscopic accessories using double channel endoscope. Whenever difficulties encountered, it can be converted to standard laparoscopic procedure. Thereby one can gradually have experience of performing the procedure with endoscopic accessories without the morbidity to the patient and hence maintaining the safety of the procedure to patients. We have performed 4 cases of trans umbilical endoscopic cholecystectomy and 8 cases of transumbilical endoscopic appendicectomy.
Double Channel gastroscope
