SUMMARY: The innovative minimally invasive surgical procedure, called Natural Orifice Translumenal Endoscopic Surgery (NOTES), involves

inserting surgical instruments and a flexible endoscope through a natural orifice, such as the mouth or the vagina, to reach the abdominal cavity is performed on a Chicago Park District physical instructor who needed her gallbladder to be removed. By avoiding the need for major incisions through the skin, muscle, and nerves of the abdomen, NOTES offer patients many benefits, such as, they recover more quickly even without taking any pain medication, experience less pain and have no visible scars on their abdomen while the risk of post-operative complications such as wound infections and hernias is significantly reduced compared to a traditional laparoscopic surgical approach. In addition, removal of the appendix and kidney along with hernia repair are some of the organ removal that has undergone NOTES. However, it has not been determined which is the optimal orifice for NOTES, and yet doctors state that the least complicated to perform in women is through transvaginal access which is one of the safest alternatives to traditional laparoscopic surgery because it uses an easily accessible natural orifice that has proven safe for over a century. On the other hand, transgastrical (mouth) access is the only approach currently available to men though the potential alternative access route that has recently been proposed for the procedure in male patients is the transrectal (anus) access. REACTION: The title of this article got my attention and soon, I gained interest so I furthermore, read it. Without a doubt, its amazing that there is such a scarless surgery called NOTES which is really beneficial to people who have physically demanding job and needs removal of their organ surgically but wants to be able to return to their full activities very quickly, has minimal post-operative pain, and no visible scars. Indeed, without incisions in the abdomen, there is no opportunity to develop surgery-related hernias and with a far lower risk for wound infections that might have resulted from traditional laparoscopic removal, which usually requires four incisions through the abdominal muscles. Patients who undergo procedures such as these recover and

resume most normal activities within just a few days. Most importantly, since the incision in the patients vagina is very small and the female reproductive organs, especially the uterus, are bypassed with this type of surgery, child bearing and sex life are not affected. RECOMMENDATION: A. To the general public I recommend that they should educate themselves about the options available to them. Single Port Surgery or Single Incision Laparoscopic Surgery (SILS), i.e. removal of the appendix or gallbladder through only one small incision hidden in the umbilicus (belly button) is another advanced minimally invasive surgery. A single port laparoscopic surgery performed with only one small incision is less invasive than the usually laparoscopic surgery, which uses three or four incisions. One incision equates to less pain, shorter recovery time and better cosmos for the patient and the ability to return to routine activities or work more quickly. Scarless Surgery or Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Single Port Surgery are becoming increasingly popular because they are even less invasive than traditional laparoscopic surgery, which still requires multiple abdominal incisions. Another advanced laparoscopic management of colon and rectal diseases with extraction of specimen through the anus or ostomy is Transanal Endoscopic Microsurgery (TEMS). TEMS is a minimally invasive approach to aid in the removal of certain rectal cancers and tumors using specialized laparoscopic equipment through the anus rather than requiring a large incision through the abdomen. TEMS can also be used to repair certain fistulas (even to the bladder or vagina), or to even excise recurrent tumors at the site of a previous anastomosis. Patients usually discharged the same day after surgery or are kept in the hospital overnight unlike the abdominal surgeries where they are in the hospital for 5-7 days. Recent studies have also shown better outcomes using TEMS compared to the traditional transanal excision.

B. To the health care professionals For now, the technique should only be offered as part of a supervised clinical research, and by a team of surgeons and advanced therapeutic endoscopists. They should attend a summit meeting or a seminar on Gastrointestinal Endoscopy so to gain knowledge regarding NOTES. Nurses should educate patients of available safe alternatives. CONCLUSIONS: Medical and surgical endoscopists were able to remove a woman's gall bladder through the vagina with the use of a flexible endoscope with only minimal external incisions. The revolutionary procedure is offered as part of an ongoing clinical research trial and may prove to have advantages, including reduced pain, quicker recovery time and absence of visible scarring. The said technique called NOTES (Natural Orifice Translumenal Endoscopic Surgery) is a procedure where in the endoscope was inserted through the patient's vaginal wall and into her body cavity. Using that endoscope (with minimal assistance from abdominally-inserted laparoscopic instruments), the gallbladder was detached and removed through the vagina, which was then sutured. Natural orifice surgery has been mainly confined to treating conditions within the gastrointestinal tract. However, the NOTES approach goes a step further into the patient's abdominal cavity. Internal incisions, such as in the vaginal wall, are less painful and may allow for quicker recovery than incisions in the abdominal wall. In addition to gall bladder surgery, NOTES approach is offered for appendectomy, abdominal exploration, and biopsy. In the future, NOTES may be performed though the mouth or the rectum. With the mouth, an incision is made in the stomach; with the rectum, an incision is made in the large intestine. Advances in minimally invasive surgical techniques over the last decade have dramatically reduced the number of open abdominal surgeries necessary eliminating a great deal of the associated discomfort. This latest revolutionary advance abdominal surgery through a natural orifice represents the culmination of this progression. This technique allows making smaller and fewer skin incisions and in the future, some abdominal surgeries will be possible without any external incisions.

SOURCES: Internet-based: Retrieved from http://www.sciencedaily.com/releases/2011/03/110310151212.htm at August 21, 2011. Retrieved from http://surgery.yale.edu/gastrointestinal/care/notes/index.aspx at August 21, 2011 Retrieved from http://www.straightfromthedoc.com/50226711/natural_orifice_translumenal_endoscopi c_surgery_notes_removed_gall_bladder_with_minimal_external_incisions.php at August 21, 2011

ANGELES UNIVERSITY FOUNDATION COLLEGE OF NURSING NURSING CARE MANAGEMENT 103 RLE

JOURNAL: Surgery Without External Scars Is Gaining Traction: Organ Removal Through Bodys Orifices Is Minimally Invasive Approach to Surgery
SUBMITTED BY: ROSE ANNE L. MAGTOTO BSN 3 2 GROUP 5

SUBMITTED TO: MA. TERESA S. CABANAYAN, R. N., M. N.

SUBMITTED ON: AUGUST 23, 2011