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Surg Innov. 2012 Dec;19(4):433-7. doi: 10.1177/1553350612438410. Epub 2012 Mar 4.

Optimizing surgical approach for natural orifice translumenal endoscopic procedures.

Author information

1
Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 1040 NW 22nd Ave, Suite 560, Portland, OR 97210, USA. mcassera@orclinic.com

Abstract

BACKGROUND:

Natural orifice translumenal endoscopic surgery (NOTES) often requires some degree of retroflexion of the endoscopic operating system. This study investigates the impact of retroflexion on task performance in NOTES.

METHODS:

In a bench-top simulation, surgeons were required to manipulate a single-channel endoscope to touch 4 dots in a predetermined order. The task was performed under the forward-view and retroflexed-view conditions.

RESULTS:

Tasks performed under the forward-view condition were significantly faster than those performed under the retroflexed-view condition (P = .005). Also, 5 experienced surgeons completed tasks in less time than the novices (P = .043). Experienced surgeons were mildly affected by the inverted image, whereas the novices were vulnerable to image malalignment.

CONCLUSION:

Careful selection of the surgical approach to avoid image malalignment is suggested for safe performance of NOTES. Extensive training is required for novices to overcome the vision-motion difficulty before they can perform NOTES safely and effectively.

PMID:
22393077
DOI:
10.1177/1553350612438410
[Indexed for MEDLINE]

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