„NOTES” – Experimentelle Erfahrungen und klinische Perspektiven

Kernaussagen

• Das Akronym „NOTES” steht für „natural orifice translumenal endoscopic surgery” und bedeutet endoskopisches Operieren in sterilen Körperhöhlen über natürliche Zugangswege.

• Tierexperimentell und mittlerweile auch in ersten klinischen Studien werden transgastrale sowie transvaginale und auch transrektale Zugänge und Techniken evaluiert.

• Ausgehend von der Entfernung infizierter Pankreasnekrosen wurden inzwischen Techniken für die Anlage von Anastomosen, die endoskopische Adaptation chirurgischer Anastomoseninsuffizienzen und für Organresektionen, wie Cholezystektomie, Apendektomie und Nephrektomie entwickelt.

• Erste klinische Anwendungen sind noch limitiert und werden in den meisten Fällen als „Hybrid-NOTES-Techniken” unter laparoskopischer Assistenz oder Kontrolle ausgeführt.

• Es ist davon auszugehen, dass vom Einsatz der Mikro- und Nanotechnologie wichtige Impulse ausgehen, von denen auch die flexible Endoskopie und die laparoskopische Chirurgie profitieren werden.

• Insbesondere für multimorbide alte Patienten oder stark Übergewichtige könnte NOTES aufgrund der geringeren Invasivität einen wesentlichen Fortschritt bedeuten.

• Wesentlich erscheint die schrittweise Einführung von NOTES, um nicht durch ein übereiltes Vorgehen unter Inkaufnahme u. U. schwerwiegender Komplikationen bei Routineeingriffen die gesamte Entwicklung in Frage zu stellen.

• In Deutschland wurde die „Initiativgruppe NOTES in Deutschland” gegründet, um eine interdisziplinäre Forschungsplattform zu schaffen und die klinische Einführung von NOTES zu begleiten.

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