What is Natural Orifice Surgery?

Natural Orifice Surgery (or NOS) is actually nothing new.  People have been inserting scopes into patients via a natural orifice (mouth, anus, vagina, nose) for decades. But in GI endoscopy NOS has been limited to very basic procedures such as diagnostics, polypectomies, simple ablations.

What is NOTES?

NOTES (Natural Orifice Translumenal Endoscopic Surgery) is a actually a subset of NOS procedures. It involves entering the body through a natural orifice, but then (and this is what's new) making a hole in the bowel or stomach and traversing the lumen to enter a new space such as the abdominal cavity.

This is exciting as it offers patients the chance for true "Scarless" surgery, the potential of less pain and faster recovery.

What's happening in NOS & NOTES?

In recent years there have been many exciting developments in both NOS and NOTES. Pioneering doctors have been performing research on how to safely perform advanced surgery using flexible scopes. What doctors have been asking for are the 'Tools' to help them to perform this type of surgery. Advanced NOS and NOTES has now moved out of the lab and cases are being performed clinically across the globe. Training courses are ongoing at institutes such as IRCAD, and new technology is coming to market to make scarless surgery a reality.

Why is it so important?

Advanced NOS and NOTES is probably more important than the move from open surgery to laparoscopy. Patients inherently do not want pain and scars - and even laparoscopy seemed "Invasive" to patients. With NOS and NOTES the mental barrier to surgery changes. But more importantly a less invasive procedure, in an outpatient setting under sedation allows a change in disease treatment. Many diseases such as appendiceal disease or diverticulosis can potentially be treated before they reach an acute phase. The barrier for the patient drops, allowing earlier intervention.