The EURO-NOTES clinical registry for natural orifice transluminal endoscopic surgery: a 2-year activity report.

Background: The EURO-NOTES Clinical Registry (ECR) was established as a European database to allow the monitoring and safe introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES). The aim of this study was to analyze different techniques applied and relative results during the first 2 years of the ECR.

Methods: The ECR was designed as a voluntary database with online access.

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas.

Background: Transanal endoscopic microsurgery as a local therapy option for rectal neoplasms is a tissue-sparing technique that protects the anal sphincter. The present retrospective analysis reports the course of observation after local excision of adenomas and T1 low-risk carcinomas using transanal endoscopic microsurgery.

Methods: In a retrospective analysis we examined data on 279 patients for local recurrence.

3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks.

Background: Common video systems for laparoscopy provide the surgeon a two-dimensional image (2D), where information on spatial depth can be derived only from secondary spatial depth cues and experience. Although the advantage of stereoscopy for surgical task efficiency has been clearly shown, several attempts to introduce three-dimensional (3D) video systems into clinical routine have failed. The aim of this study is to evaluate users' performances in standardised surgical phantom model tasks using 3D HD visualisation compared with 2D HD regarding precision and working speed.

Single-port surgery and NOTES: from transanal endoscopic microsurgery and transvaginal laparoscopic cholecystectomy to transanal rectosigmoid resection.

Two different ways have been developed to perform endoscopic surgery. The standard way is multiport laparoscopic surgery. When entering through a natural orifice, we use single-port surgery for transanal work (transanal endoscopic microsurgery).

A novel single-port technique for transanal rectosigmoid resection and colorectal anastomosis on an ex vivo experimental model.

Background: In the context of natural orifice translumenal endoscopic surgery (NOTES), we developed a new set of rigid instruments according to the principles of transanal endoscopic microsurgery (TEM).These instruments are long, curved, and steerable by rotating two wheels near its handle. Our success in transvaginal cholecystectomy in human with these instruments motivated us to explore the feasibility of rectosigmoid resection through the anus.

Artificial tactile feedback can significantly improve tissue examination through remote palpation.

Background: In laparoscopy, impaired feedback information from the operation site and reduced instrument dexterity lead to high demands on surgeons' skill and experience. Pre-clinical studies have shown that artificial tactile feedback (ATF) could significantly improve the quality of tactile feedback information. Additional information about interaction effects of tissue features when using ATF as well as related detection thresholds would be valuable for drawing conclusions on possible clinical application scenarios.

EAES recommendations on methodology of innovation management in endoscopic surgery.

Background: Under the mandate of the European Association for Endoscopic Surgery (EAES) a guideline on methodology of innovation management in endoscopic surgery has been developed. The primary focus of this guideline is patient safety, efficacy, and effectiveness.

Methods: An international expert panel was invited to develop recommendations for the assessment and introduction of surgical innovations.

[Natural orifices transluminal endoscopic surgery (NOTES) in Germany: summary of the working group reports of the "D-NOTES meeting 2009"].

The D-NOTES-group met in June 2009 for an evaluation of ongoing preclinical and clinical activities in natural orifice endoscopic surgery and the further coordination of research in Germany. Different working groups with various topics were formed. Consensus statements among various participants with different scientific and medical background were initiated.

Review on aspects of artificial tactile feedback in laparoscopic surgery.

Since direct manual tissue palpation is not possible in laparoscopic surgery, feedback information on tactile tissue properties is considerably diminished. Restoring part of the surgeon's sense of touch through devices capable of providing artificial tactile feedback (ATF) is an active field of applied research and development. Despite more than two decades of research, technical development of such devices is still basic, and pre-clinical as well as clinical experience is limited.

[Transanal endoscopic microsurgery in the treatment of rectal tumors: a prospective study in 50 patients].

Background: The medical literature accepts local resection as a valuable option in selected cases of rectal tumors. Selection of patients requires an exact perioperative estimation of risks with clinical and histopathological examination. Transanal endoscopic microsurgery aims a safe resection of the tumoral area which leads up to the cure.

Experimental trial of transvaginal cholecystectomy: an ex vivo analysis of the learning process for a novel single-port technique.

Background: Interest in natural orifice transluminal endoscopic surgery (NOTES) has expanded, and the first experiences with patients using different techniques have been reported. However, no work has addressed the learning process or the limitations of the procedures. The relation between inexperience and complications became a major concern after the introduction of laparoscopic surgery.

Instruments for transluminal laparoscopic surgery or "NOTES".

The first endoluminal operation ever developed was transanal endoscopic microsurgery (TEM), years before laparoscopic cholecystectomy was first performed. Numerous procedures using its single port system (SPS) have since been done and it is now a well-established technique in colorectal surgery around the world. There are some advantages of SPS over multiple port surgery.

[Experimental study on a new method for colonoscopic closure of large-bowel perforations with the OTSC clip].

Iatrogenic perforation of the colon during interventional endoscopic procedures, e.g., mucosectomy, is a problematic complication, as safe treatment often requires surgical repair.

The OTSC clip for endoscopic organ closure in NOTES: device and technique.

The closure of the gastrotomy in Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a prerequisite for transgastric endoscopic procedures in the abdominal cavity. Different techniques have been proposed and are under experimental or early clinical investigation. We describe the technique of using an over-the-scope-clip system (OTSC), made of super-elastic Nitinol and a specially designed tissue-approximating double jaw endoscopic grasper for gastric closure.

Laparoscopic intracorporal colorectal sutured anastomosis using the Radius Surgical System in a phantom model.

Background: The Radius Surgical System (RSS) is a manipulator with additional degrees of freedom to enhance the dexterity of laparoscopic suturing. Our aim was to determine the feasibility and potentially added value of laparoscopic intracorporal sutured colorectal anastomosis (RSS) compared with suturing with conventional laparoscopic instruments (CLI).

Methods: A total of 72 colorectal anastomoses and 30 single sutures using RSS and CLI were performed in the study.

Development of a transoral fundoplication device and related experimental research.

This paper describes a device and surgical techniques developed between 1999 and 2003 to enable an entirely transoral approach to fundoplication. The Endofundoplication System (EFS) system consisted of a multifunctional flexible tube for oral introduction (18 mm) as the key component, with a specially designed retroverted grasper that was used to grasp the lower esophageal sphincter (LES) area of the esophagus, for invaginating the LES into the stomach and folding the gastric wall onto the wall of the intraabdominal esophagus. The EFS system was finally studied in a consecutive series of animal experiments in the domestic pig (n = 10).

Precision in stitches: Radius Surgical System.

Background: The Radius Surgical System is a manual manipulator with two additional degrees of freedom compared with conventional laparoscopic instruments (CLIs). This study aimed to compare the performance of laparoscopic suturing tasks with the use of the Radius Surgical System and CLIs, respectively.

Methods: Five experienced laparoscopic surgeons performed laparoscopic surgical tasks in a training box.

Ergonomics with the use of curved versus straight laparoscopic graspers during rectosigmoid resection: results of a multiprofile comparative study.

Background: A detailed ergonomic comparison of motions and muscular activity in the left upper extremity using a laparoscopic straight or curved grasper in rectosigmoid resection is presented.

Methods: The study had two parts: experimental and clinical. In the experiment part, 30 laparoscopic sigmoid resections were performed under animal organ phantom conditions.

The radius surgical system - a new device for complex minimally invasive procedures in urology?

Objective: Complex laparoscopic procedures in urology are technically demanding with an extended learning curve. Robotic systems add significant cost to laparoscopic procedures. We therefore evaluated the use of the Radius Surgical System (RSS), a mechanical manipulator, for complex laparoscopic cases in urology.

Experimental results of mesh fixation by a manual manipulator in a laparoscopic inguinal hernia repair model.

Background: Laparoscopic mesh fixation using a stapler can lead to complications such as nerve injury and bowel injury. However, mesh fixation by suturing with conventional laparoscopic instruments (CLI) is difficult because of limited degrees of freedom. A manual manipulator--Radius Surgical System (Radius)--whose tip can deflect and rotate, gives the surgeon two additional degrees of freedom.

An innovative trainer for surgical procedures using animal organs.

Since 1990, almost 3000 surgeons have absolved the training course for minimally invasive surgery in our training center. A phantom trainer using animal organs has been used as a training device. Based on this experience, we have developed an innovative trainer for surgical procedures using animal organs.