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Please Doctor, Resist NOTES!

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  • Laparoscopy
  • Results
  • Complication
  • Sils
  • Surgery
  • Vagina
  • Human Health Sciences :: Surgery [D26]
  • Sciences De La Santé Humaine :: Chirurgie [D26]
  • Medicine
  • Philosophy


SLA202537.dvi LETTER TO THE EDITOR Please Doctor, Resist NOTES! To the Editor: I n the August issue of Annals of Surgery,Lehmann et al reported on the Ger- man experience with 551 Natural Orifice Translumenal Endoscopic Surgery (NOTES) procedures.1 NOTES has been proposed as a new surgical innovation allowing surgical procedures via natural orifices to achieve im- proved surgical cosmetic results. For abdom- inal surgery, these potential orifices are the vagina, the mouth (through a gastrotomy), or the anus (through a rectotomyor a colostomy). The article by Lehmann et al is a report on the voluntary registry of procedures, mainly cholecystectomies, performed on women us- ing a hybrid, rather than pure NOTES tech- nique. Most cases presented in the report involved 10 mm transvaginal access and 5 mm umbilical trocar, with a follow-up pe- riod of 1 month.1 Mean hospital stay for these cholecystectomies was 3.2 days. The authors reported a few intra- and postopera- tive complications, most of which were mi- nor and related to the vaginal access. In our opinion, this report raises several significant issues. First, caution has to be taken when we, surgeons, evaluate complications occurring in our own practice on a purely voluntary retro- spective basis. We have a natural tendency to neglect or forget some of the complications encountered. To illustrate this, it is very in- triguing that this report of 488 hybrid NOTES cholecystectomies does not describe any bile duct injury, a complication that is known to be significantly more common in “classical” laparoscopic cholecystectomies than in open cholecystectomies.2 There is no reason for hybrid NOTES techniques to be safer than the standard practice, especially if bile duct opacification is not performed.3 The compli- cations of a new procedure such as NOTES must be evaluated prospectively if a study is to be meaningful. In addition, I do not agree with the au- thors’ argument that an ethical review is not necessary when proposing a NOTES te

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