NOTES: The hybrid technique

Introduction: Natural orifice translumenal endoscopic surgery (NOTES) has gained much interest by minimal invasive surgeons and gastroenterologists. Performing abdominal operations without any abdominal wall incisions may offer all the advantages of minimally invasive surgery (MIS) and eliminate the complications associated with these wounds. The NOTES technique is rapidly being developed, but one of the major issues involved in the procedure that has to be addressed prior to implementation is in obtaining adequate spatial orientation. Objective: The aim of this study was to combine the standard laparoscopic vision together with the endoscopic surgery procedure in order to acquire an independent satisfactory vision source. Materials and Methods: The hybrid technique was performed in 6 porcine animal models. Among the procedures performed were tubal ligation, liver biopsies, oophorectomy, and cholecystectomy. All procedures were performed under general anesthesia, and all animals were euthanized at the termination of the procedure. Results: The laparoscopic vision offers substantial advantages over the endoscopic vision. Spatial orientation is achieved in the same manner and quality as in MIS, and furthermore, the laparoscopic vision increases the safety of the NOTES procedure. Conclusions: The hybrid technique offers a superior vision source independent to the working endoscope. It may be an interim technique for developing NOTES until a novel imaging device will be available, or serve as the final solution for acquiring an adequate vision for this approach.