[Endoscopic transvaginal cholecystectomy]. / Colecistectomía endoscópica transvaginal.

INTRODUCTION: Transluminal endoscopic surgery through natural orifices (NOTES) allows intraperitoneal surgical procedures with minimal access to the abdominal wall. Currently it is not yet possible to perform these interventions without laparoscopic assistance, so these procedures are hybrids, fusion of minilaparoscopy and transluminal endoscopic surgery We present a prospective clinical series of patients undergoing surgery for gallstones, with hybrid NOTES transvaginal cholecystectomy with a nursing care plan adapted to this new approach. METHODS: Prospective clinical series of consecutive patients, nonrandomized, with transvaginal NOTES cholecystectomy. The surgery was performe with the assistance of two parietal entryports, one of umbilical 5 mm and 3 mm right upper quadrant of the abdomen. Analysis of nursing care plan with particular attention to safety of the procedure parameters and anxiety associated to the surgery RESULTS: There were no serious systemic complications. The main problem with this type of surgery is the fear of patients in relation to the new ways for a non-gynecological transvaginal procedures as ckolecystectomy and the risk of vaginal bleeding and urinary infection. DISCUSSION: Hybrid transvaginal cholecystectomy is a good surgical model of minimally invasive surgery. Its implementation is possible in groups with habit laparoscopic surgery, using standard instrumentation of endoscopy and laparoscopic surgery. The surgical team, doctors and nurses, must be well prepared for this new approach, because special and innovative cares are demanded.

Colecistectomía endoscópica transvaginal / Endoscopic transvaginal cholecystectomy

Introducción. La cirugía endoscópica transluminal a través de orificios naturales (NOTES) permite realizar procedimientos quirúrgicos intraperitoneales con mínimos accesos en la pared abdominal. Actualmente todavía no es posible realizar estas intervenciones sin asistencia desde puertas de entrada en la pared abdominal, por lo que los procedimientos realizados son híbridos, fusión de minilaparoscopia y cirugía endoscópica transluminal. Se presenta una serie clínica prospectiva de pacientes intervenidas por colelitiasis, a las que se practicó colecistectomía híbrida transvaginal, con un plan de cuidados de colecistectomía laparoscópica adaptado al nuevo abordaje endoscópico transvaginal. Métodos. Serie clínica prospectiva de pacientes consecutivas, no aleatorizada, intervenidas por colelitiasis mediante abordaje de fusión NOTES transvaginal y minilaparoscópico con dos puertas de entrada, umbilical de 5 mm y en hipocondrio derecho de 3 mm. Análisis del plan de cuidados de enfermería, prestando especial atención a parámetros de seguridad del procedimiento y ansiedad relacionada con la cirugía. Resultados. No existieron complicaciones generales graves. El principal problema relacionado con este tipo de cirugía es el miedo de las pacientes en relación a las nuevas vías de abordaje transvaginal para procedimientos no ginecológicos y el riesgo de sangrado vaginal y de infección urinaria. Discusión. La colecistectomía híbrida transvaginal constituye un buen modelo quirúrgico de cirugía mínimamente invasiva. Su implantación es posible en grupos quirúrgicos que tengan hábito laparoscópico, empleando instrumentación habitual de endoscopia y cirugía laparoscópica. El equipo quirúrgico -facultativos y enfermeros- debe estar bien preparado para este tipo de abordajes, pues precisan unos cuidados específicos y novedoso (AU)

Introduction. Transluminal endoscopic surgery through natural orifices (NOTES) allows intraperitoneal surgical procedures with minimal access to the abdominal wall. Currently it is not yet possible to perform these interventions without laparoscopic assistance, so these procedures are hybrids, fusion of minilaparoscopy and transluminal endoscopic surgery. We present a prospective clinical series of patients undergoing surgery for gallstones, with hybrid NOTES transvaginal cholecystectomy with a nursing care plan adapted to this new approach. Methods. Prospective clinical series of consecutive patients, nonrandomized, with transvaginal NOTES cholecystectomy. The surgery was performe with the assistance of two parietal entryports, one of umbilical 5 mm and 3 mm right upper quadrant of the abdomen. Analysis of nursing care plan with particular attention to safety of the procedure parameters and anxiety associated to the surgery. Results. There were no serious systemic complications. The main problem with this type of surgery is the fear of patients in relation to the new ways for a non-gynecological transvaginal procedures as ckolecystectomy and the risk of vaginal bleeding and urinary infection. Discussion. Hybrid transvaginal cholecystectomy is a good surgical model of minimally invasive surgery. Its implementation is possible in groups with habit laparoscopic surgery, using standard instrumentation of endoscopy and laparoscopic surgery. The surgical team, doctors and nurses, must be well prepared for this new approach, because special and innovative cares are demanded (AU)

NOTES. Historia y situación actual de la cirugía endoscópica por orificios naturales en nuestro país / NOTES. History and current situation of natural orifice transluminal endoscopic surgery in Spain

La cirugía endoscópica transluminal a través de orificios naturales (NOTES, del inglés Natural Orifice Translumenal Endoscopic Surgery), engloba un conjunto de nuevas vías de abordaje endoscópico de la cavidad abdominal, con ventajas potenciales sobre la cirugía laparoscópica convencional. Se fundamenta en la posibilidad de realizar técnicas quirúrgicas intraperitoneales mediante la entrada en la cavidad peritoneal a través de los orificios naturales perforando el órgano que permite la entrada directa a dicha cavidad (estómago, vagina, recto, vejiga). Posteriormente se ha postulado la posibilidad de este mismo acceso para acceder al retroperitoneo y al mediastino. A continuación se comenta como se ha desarrollado la técnica y cómo ha sido la aplicación en nuestro país, intentado dar una visión general sobre los riesgos y beneficios de la NOTES y las necesidades básicas para poder iniciarse en esta nueva cirugía (AU)

Natural orifice transluminal endoscopic surgery (NOTES), involves a group of new endoscopic approaches to the abdominal cavity, with potential advantages over conventional laparoscopic surgery. It is based on the possibility of performing intra-peritoneal surgical techniques through natural orifices by entering the peritoneal cavity through natural orifices perforating the organ that allows direct access to that cavity (stomach, vagina, rectum, bladder). The possibility of using this same route to access the retroperitoneum and mediastinum has subsequently been postulated. Comments are made on how the technique has been developed, as well as how it has been applied in our country, attempting to give a general view on the risks and benefits of NOTES and the basic requirements to be able to start in this new surgery (AU)

[NOTES. History and current situation of natural orifice transluminal endoscopic surgery in Spain]. / NOTES. Historia y situación actual de la cirugía endoscópica por orificios naturales en nuestro país.

Natural orifice transluminal endoscopic surgery (NOTES), involves a group of new endoscopic approaches to the abdominal cavity, with potential advantages over conventional laparoscopic surgery. It is based on the possibility of performing intra-peritoneal surgical techniques through natural orifices by entering the peritoneal cavity through natural orifices perforating the organ that allows direct access to that cavity (stomach, vagina, rectum, bladder). The possibility of using this same route to access the retroperitoneum and mediastinum has subsequently been postulated. Comments are made on how the technique has been developed, as well as how it has been applied in our country, attempting to give a general view on the risks and benefits of NOTES and the basic requirements to be able to start in this new surgery.

Cirugía laparoscópica a través de incisión única / Single incision laparoscopic surgery

Uno de los objetivos de las nuevas tecnologías y técnicas en cirugía mínimamente invasiva es lograr una cirugía sin o con mínimas cicatrices visibles. La cirugía a través de orificios naturales podría considerarse como un paradigma de este desarrollo pero todavía no ha sido posible su completa implantación. Sin embargo, la innovación resultante de la investigación en cirugía a través de orificios naturales ha permitido introducir una serie de «tecnologías puente» que permiten desarrollar la cirugía mínimamente invasiva con los estándares de eficacia y seguridad exigibles, siendo la cirugía laparoscópica a través de incisión única el concepto más atractivo en este momento. El objetivo de este trabajo es revisar el concepto de cirugía laparoscópica a través de incisión única y clasificar las herramientas disponibles para su implantación y desarrollo (AU)

One of the aims of the new technologies and techniques in minimally invasive surgery (MIS) is to achieve a surgery without or with minimal visible scars. Natural orifice transluminal endoscopic surgery (NOTES) might be considered to be a paradigm of this development but it has not yet been possible to implement this universally. Nevertheless, the resultant innovation of research into NOTES has enabled “bridge technologies" to be introduced that allow MIS to be developed with the required standards of efficiency and safety. The aim of this paper is to review the concept of single incision surgery and to classify the available tools for its development and implementation (AU)

[Single incision laparoscopic surgery]. / Cirugía laparoscópica a través de incisión única.

One of the aims of the new technologies and techniques in minimally invasive surgery (MIS) is to achieve a surgery without or with minimal visible scars. Natural orifice transluminal endoscopic surgery (NOTES) might be considered to be a paradigm of this development but it has not yet been possible to implement this universally. Nevertheless, the resultant innovation of research into NOTES has enabled "bridge technologies" to be introduced that allow MIS to be developed with the required standards of efficiency and safety. The aim of this paper is to review the concept of single incision surgery and to classify the available tools for its development and implementation.