Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Over time, since man has learned to use surgical treatments to cure, the picture one could not avoid bringing to mind was that of long scars across the body, or stitches resembling something like a centipede or a railway track. Surgical techniques have come a long way since its beginning, with the introduction and application of new, innovative techniques, particularly the use of miniature cameras to aid doctors in performing surgery. This innovation has provided the benefits of much smaller incisions and better postoperative quality of life for patients (small incision, less pain) and it is properly known as laparoscopic surgery. Today, laparoscopic surgery continues to advance at a rapid rate, its primary objective being to reduce the size of surgical incisions and thus minimize pain or trauma to tissue in the body, in accordance with the principles behind Minimally Invasive Surgery (MIS).

Conventional Laparoscopic Surgery

With conventional laparoscopic surgery, one can expect two to four very small incisions in the abdominal area, approximately 0.5 to 1 cm each.  By contrast, with traditional open abdominal surgery, the size of the incision on the abdomen is about eight to 15 cm long. The main advantages of conventional laparoscopic surgery, then, are far less postoperative pain and a much shorter recovery period, allowing the patient to return to their everyday life and activities much more quickly. Additionally, the obvious cosmetic advantage is the greatly reduced incision size.

Single-Port Laparoscopic Surgery

Conventional laparoscopic surgery has been further developed to what is now called single port laparoscopic surgery. From what used to be two to four incision sites with the conventional method, has now been reduced to a single small incision at the entry point—the umbilicus. The key benefit of single port laparoscopic surgery is its highly superior cosmetic results; as once the procedure is finished, the umbilicus is gently folded back into its original position, and thus the healed incision leaves practically no visible scar. The many other benefits are comparable to those of conventional laparoscopic surgery.

Scarless Abdominal Surgery

Scarless abdominal surgery, or as it is known in medical terms, Natural Orifice Transluminal Endoscopic Surgery (NOTES), is a form of laparoscopic surgery that has been further advanced and developed from the conventional laparoscopic surgery approach, but with entry through a natural orifice, such as the mouth, anus, vagina, etc. The safest and most favored approach at present is transvaginal. The transvaginal approach is accomplished by passing the tiny camera and instruments through the vaginal cavity to perform surgery. Because every phase of this surgical procedure is performed using the vaginal port, it means that the most obvious advantages are the aesthetic and cosmetic benefits, since there is no incision made in the abdominal area. With this procedure, the postoperative pain is far less than with any other kind of laparoscopic surgery that goes through the abdomen and it also boasts a much faster postoperative recovery period.

Comparative Table of Laparoscopic Surgery Types

  Open  Abdominal  Surgery Conventional  Laparoscopic Surgery Single-Port  Laparoscopic  Surgery Natural Orifice Transluminal  Endoscopic Surgery (NOTES)
Abdominal Incision 8-15 cm  0.5-1 cm,  2-4 sites  2 cm, 1 site in the umbilicus  No incisions in the abdominal area
Postoperative pain Significant Minimal  Minimal  Least
Hospital recovery  period 3-5 days  2-3 days  2-3 days  1-2 days
Probability of  postoperative fibrosis High  Low  Low  Extremely Low
Risk level of surgical  site infection Present  Low  Low  Extremely Low
Risk level for  incisional hernia Present  Very Low  Very Low  Non-existent


Gynecological Conditions Treatable Using Single-Port and Scarless Laparoscopic Surgery

  • Ovarian tumors requiring removal of the uterus (hysterectomy)
  • Removal of uterine fibroids requiring preservation of the uterus (myomectomy)
  • Certain ovarian cyst types, requiring removal of the cysts only (cystectomy), or removal of fallopian tubes together with whole ovary (salpingo-oophorectomy)
  • Ectopic pregnancies requiring removal of one or both fallopian tubes (salpingectomy)
  • Female sterilization (tubal sterilization)
  • Early stage abnormal cervical cells, such as abnormal cells in the cervix or endometrium requiring removal of the uterus (hysterectomy)

Limitations of Single-Port and Scarless Laparoscopic Surgery

  • Cannot be performed on patients with a large number of fibroids in the pelvic area
  • Cannot be used for metastatic gynecologic cancer
  • Cannot be performed on patients with severe heart or lung diseases

Particular natures of various diseases require varying types of surgical procedures. Patients who are interested in undergoing single port or scarless laparoscopic surgery must first receive a thorough physical examination and evaluation by an experienced OB/GYN specializing in gynecologic laparoscopic surgery. This exam is done in order to determine the feasibility of single port or scarless laparoscopic surgery in that particular patient, as well as to identify which method would be best suited to the patient and their specific needs, and to allow all of our patients to receive the greatest benefit possible from the treatment provided.

Learn more about minimally invasive surgery and packages at Samitivej Sukhumvit Hospital.


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