Wer macht in Zukunft NOTES? Gastroenterologe, Chirurg, endoskopischer Interventionalist?

Zusamenfassung

Wie der NOTES-Interventionlist der Zukunft aussieht ist derzeit nicht vorhersehbar. Gleichermaßen nicht, aus welcher „Mutterdisziplin” er entspringen wird. Kommt es mehr darauf an, Virtuosität in der präzisen, schlafwandlerisch sicheren Bedienung von herkömmlichen flexiblen Endoskopen aufzuweisen oder ist es wichtiger, sich in einem speziellen anatomisch-pathologischen Terrain fachgebietsbezogen auszukennen? Gilt Operieren im Abdomen = Viszeralchirurgie, Entfernung der Niere = Urologie, Tubenligatur = Gynäkologie oder gilt das handwerkliche Geschick als wesentlich, gepaart mit einem limitierten, auf die Intervention zentriertem Hintergrundwissen, ähnlich wie Interventionen in der Radiologie in verschiedene Fachgebiete hineinreichen und es mehr auf hoch spezialisiertes Geschick ankommt. Derzeit bewegen sich Gastroenterologen und minimalinvasive Chirurgen klinisch nur zögerlich von sicherem Boden der jeweiligen Fachdisziplin zu NOTES. Gastroenterologen werden die kommenden Jahre endoskopisches Nähen, Perforationsverschlüsse und gastroenterologische Anastomosen durchführen. MIC-Chirurgen beschäftigen sich mit „Single Port Access” transvaginal oder i. R. von E-NOTES umbelical. Ein neues Ausbildungscurriculum für den „endoskopischen Interventionalisten” sollte in naher Zukunft aufgegriffen werden.

Abstract

It is currently unpredictable how the NOTES interventionalist of the future will look like and which “mother discipline” he will originate from. Will it be more important to be a specialist and virtuoso in conventional flexible therapeutic endoscopy or will count a prior experience in a patho-anatomical field. Will mean endoscopic surgery in the abdomen = visceral surgery, endoscopic nephrectomy = urology, tubal ligation = gynacology or will a limited scientific background focussed on the intervention be sufficient similar to the skills of an interventional radiologist? Clinically gastroenterologists currently concentrate on endoscopic sewing, closure of perforations and endoscopic anastomoses. Surgeons currently concentrate on rigid “single port access” surgery transvaginally or transumbelically (“E-NOTES”) until new instruments will be created by industry. A new curriculum for the “endoscopic interventionalist” should be brought on its way soon.

endoskopisches Operieren über natürliche Körperöffnungen - interventionelle Endoskopie - minimalinvasive Chirurgie - Training - E-NOTES - „Single Port” Chirurgie

natural orifice translumenal endoscopic surgery - interventional endoscopy - minimal-invasive surgery - training - E-NOTES - single port surgery

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