Natural Orifice Translumenal Endoscopic Surgery (NOTES): What are We Getting Into?
Notice bibliographique
Résumé
1Division of Gastroenterology; 2School of Computing, Department of Mechanical and Materials Engineering, Department of Surgery, Hotel Dieu Hospital, Kingston, Ontario Correspondence: Dr Lawrence C Hookey, Queen's University, Division of Gastroenterology, Hotel Dieu Hospital, 166 Brock Street, Kingston, Ontario K7L 5G2. Telephone 613-544-3310, fax 613-544-3114, e-mail hookeyl@hdh.kari.net WHAT IS NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY? For most gastroenterologists, one of the first rules of endoscopy is to diligently avoid perforation of the gastrointestinal lumen. While this principle remains true in the majority of cases, therapeutic crossing of the gastric or duodenal lumen is now accepted for pancreatic pseudocyst drainage and percutaneous gastrostomy tube placement. Endoscopic ultrasound-guided fine needle aspiration of abnormalities in the abdomen and mediastinum has further pushed this barrier. Natural orifice translumenal endoscopic surgery (NOTES), first described in 2004 (1), extends the concept of extraluminal endoscopic intervention to another level. The technique begins with the creation of an opening in a natural lumen (most often gastric, although colonic, vesical, vaginal and uterine approaches have been described) using either electrosurgical incision or needle puncture followed by balloon dilation. An endoscope is then passed through the opening, with pneumoperitoneum provided through the endoscope. Procedures such as cholecystectomy and oophorectomy are performed using traditional (snares, biopsy forceps, endo-loops) and nontraditional (endoscopic suturing devices) endoscopic equipment. Upon withdrawal of the endoscope back into the lumen, the wall defect is closed using clips or sutures. Although most work has been limited to animal experiments (most commonly pigs), Drs Reddy and Rao, from the Asian Institute of Gastroenterology in Hyderabad, India, have performed a limited number of transgastric appendectomies in humans (personal communication). The main potential advantages of NOTES are related to the lack of transabdominal incisions. This could possibly reduce anesthetic requirements and postoperative pain, leading to faster recovery. The lack of restricted inspiration secondary to abdominal wall pain could potentially lead to a lower rate of postoperative atelectasis and pneumonia. In addition, patients who traditionally have poorer outcomes with open surgery (those with chronic obstructive pulmonary disease, the morbidly obese, corticosteroid users) may be particularly suited to NOTES, with its potential for easier access to the peritoneum and decreased postoperative recovery. The cosmetic advantage of NOTES, or ‘scarless surgery’, is obvious. However, the importance of this is still debated (2) and the significance that patients would place on this remains to be determined.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».