Scarless Surgery

Natural Orifice Transluminal Endoscopic Surgery (NOTES): an Emerging Technique in Surgery:

Minimally-invasive surgery or scarless surgery has gained significant popularity in Kolkata because of its advantages over traditional open surgical techniques, such as less post-operative pain, less analgesics requirements, a short hospital stay, early return to work, fewer complications and better cosmesis. Conventional minimally-invasive techniques involve accessing organs through naturally existing body cavities or anatomical planes, percutaneously, for visualisation and instrumentation, thereby leaving behind a few external scars permanently. Natural orifice transluminal endoscopic surgery or NOTES, a recent concept, originates as an extension of interventional endoscopy, but more recently it is adopted by laparoscopic surgeons and surgical endoscopists as a less invasive form of laparoscopy.

Principles of NOTES:

Access to the intra-abdominal organs is gained through natural orifices such as the mouth and vagina, although there are reports of access through the rectum and urinary bladder. The stomach or vagina is punctured and carbon dioxide is insuflated through the endoscope. The pneumoperitoneum created is maintained, thus developing a working space for the performance of intra-abdominal procedures.

Advantages of NOTES over conventional laparoscopic surgery:

  • Improved cosmetic appearance,
  • less postoperative pain,
  • reduction in the MRSA infection,
  • reduced incidence of wound site hernias and
  • reduction in the psychological impact of the trauma and discomfort of surgery.

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