Prevention of Postoperative Malnutrition with Oral Nutritional Supplements in Patients Undergoing Gastrointestinal Surgery.

Oral nutritional supplements (ONSs) offer support for the nutritional needs of surgical patients. However, their efficacy is contingent upon the nutrient composition, absorption efficiency, and postingestion tolerance. Our study included a cohort of 84 patients who underwent elective open surgery involving at least one intestine anastomosis. To mitigate the risk of malnutrition, 2 groups of 28 patients each received either a high-protein low-osmotic ONS (Group I) or a high-calorie high-osmotic ONS (Group II). A standard diet was used in the control group (Group III). The metabolic effects were evaluated by measuring body weight and relative change in body weight (Δkg) from 24 h (-1 day) presurgery to 28 days postprocedure. Subjective tolerance following ONS consumption on the second postoperative day was also assessed. Our findings showed that, across all groups, the average body weight decreased during the initial 2 weeks postsurgery, subsequently stabilizing or returning to baseline levels by the third and fourth week of observation. Patients receiving ONS demonstrated greater weight gain between days 14 and 28, with Group I exhibiting the highest rate of gain. Low-osmotic ONS displayed superior tolerance and elicited fewer patient complaints postconsumption. Postoperative hospitalization duration did not differ significantly among the nutritional strategies. In conclusion, early administration of ONS supplies essential nutrients and facilitates refeeding, thereby reducing the risk of malnutrition. Low-osmotic preparations are better tolerated and contribute more effectively to the restoration of preoperative body weight, despite their lower caloric content.

Principles of minimize bleeding and the transfusion of blood and its components in operated patients - surgical aspects.

One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.

Healing Peristomal Wounds Around Retracted Stomas with Negative-Pressure Wound Therapy: A Case Series.

ABSTRACT: One method for treating a retracted stoma is a vacuum dressing that cleans the wound and protects against intestinal leakage. This case series describes the use of an integrated, single-use negative-pressure wound therapy (NPWT) dressing to treat retracted stomas as an alternative to other noninvasive remedies. The report includes seven patients who were hospitalized in the authors' surgical department from 2019 to 2020. All patients developed severe peristomal infection that failed to respond to local treatment with proper ostomy appliances or specialist dressings. After cleaning each wound and removing necrotic lesions, the authors applied a single-use hydrofiber NPWT dressing to each patient. The dressing was changed every 2 to 5 days, depending on the effects of the therapy. The stoma orifice was covered with a bag with two-piece ostomy systems. The peristomal wound healed in all cases, and leakage was eliminated. The mean time of treatment was 14 days (range, 10-21 days), and the vacuum dressings were changed an average of four times (range, 3-7 times). None of the patients required a stoma translocation or other additional surgery. Three patients received systemic IV antibiotic therapy to treat general infection. Single-use NPWT dressings protect peristomal wounds from bowel leakage and do not hinder the application of stoma bags. This system, similar to standard NPWT devices, effectively protects infected stomas from retraction.

Dehiscence of colorectal anastomosis treated with noninvasive procedures.

Introduction: Most postoperative rectal leakages can be successfully treated with minimally invasive procedures. Endoscopic vacuum therapy supported by tissue adhesives or cellular growth stimulants closes even chronic anastomotic fistulas. Aim: To present a treatment strategy for postoperative leakage of rectal anastomoses with noninvasive procedures. Material and methods: From 2015 to 2020, a group of 25 patients with postoperative rectal leakage was enrolled for minimally invasive treatment. The indication for the therapy was anastomotic dehiscence not exceeding 1/2 of the bowel circuit and the absence of severe septic complications. All patients were healed with endoluminal vacuum therapy (EVT) supported by hemostatic clips, tissue adhesives or cellular growth stimulants. Results: Complete drainage and reduction of leakage were achieved in 23 patients. The fistula was totally closed in 21 patients and in 2 of them it was restricted to a slit sinus. Two patients required revision surgery. Endoscopic treatment attempted within 7 days from leakage detection, as well as the size of the dehiscence less than 1/4 of the bowel circuit, increased the chance of full healing. In contrast, ultra low resection and neoadjuvant radiotherapy impaired the healing process, limiting the effectiveness of noninvasive therapy. Conclusions: The minimally invasive approach successfully restricts anastomotic leakage and reduces the diameter of dehiscence. Early initiation of the therapy and the size of rupture determine the final results. The use of complementary endoscopic solutions, such as clips or tissue adhesives, increases the effectiveness of the noninvasive strategy.

Minimally Invasive Treatment of Recurrent Anal Fistulas with Autologous Platelet-Rich Plasma Combined With Internal Orifice Closure.

AIM: Minimally invasive procedures for the treatment of anal fistulas are gaining more and more popularity. For this purpose, Platelet-Rich Plasma (PRP) are administered to accelerate the healing process of various difficult wounds or lesions. The aim of this study was to evaluate preliminary results of PRP injection into the tissues adjacent to anal fistulas. PATIENTS AND METHODS: A cohort of 42 patients with recurrent anal fistula, who underwent at least one cutting procedure previously, were enrolled into this preliminary and prospective trial. Closure of internal orifice was performed in all investigated patients, however, in 22 patients from group I, that procedure was combined with topical injection of PRP. In the postoperative period, the PRP administration could be repeated in case of incomplete fistula closure. Follow-up consisted of out-patient visits in a fortnight, 1, 2, and 12 months. RESULTS: Complete closure of anal fistulas was achieved in 16 (75%) patients from group I and 10 (45,5%) patients from group II. The fistulas were healed in 9 patients from group I after single application of PRP. In the next 9 patients with incomplete fistula closure, the injection was repeated 2 to 4 times every fortnight leading finally to complete recovery in 6 of them. CONCLUSIONS: Surgical fistula closure with local PRP application spares the anal sphincter and gives the opportunity to repeat the procedure several times if necessary. Treatment of recurrent anal fistulas with PRP can be considered as last resort therapy.

Minimally invasive treatment of postoperative fistulas, leakages, and perforations of the upper gastrointestinal tract: a single-center observational study.

Introduction: Most anastomotic leaks in the upper gastrointestinal (GI) tract can be treated with minimally invasive techniques dominated by endoluminal vacuum therapy (EVT) or stent implantation. Chronic leaks often require additional solutions, such as tissue adhesives or cellular growth stimulants. Aim: To present a treatment strategy for postoperative leakage of upper GI anastomoses with noninvasive procedures. Material and methods: A group of 19 patients treated in the period 2015-2023 with postoperative upper GI tract leakage was enrolled for endoscopic treatment. The indication for the therapy was anastomotic dehiscence not exceeding half of the circumference and the absence of severe septic complications. All patients were managed using endoscopic vacuum therapy (EVT) or a self-expanding stent while persistent fistulas were additionally treated with alternative methods. Results: The EVT was successfully implemented in 13 cases, but 7 patients required alternative methods to achieve definitive healing. Self-expanding stent placement was performed in 6 patients; however, in 3 cases a periprosthetic leakage occurred. In this group, 2 patients had the stent removed and the third one died due to septic complications. Post-treatment stenosis was identified in 5 patients after EVT that required balloon dilation with acceptable resolution in all cases. Conclusions: Early detected anastomotic dehiscence limited to half of the circumference most effectively responded to the noninvasive treatment. Nutritional support as well as complementary endoscopic solutions such as tissue adhesives, growth stimulants and hemostatic clips increase the percentage of complete healing.

Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery.

Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.

Endoscopic Surveillance and Treatment of Upper GI Tract Lesions in Patients with Familial Adenomatous Polyposis-A New Perspective on an Old Disease.

Familial adenomatous polyposis (FAP) is an autosomal dominant disease caused by a germline mutation in the adenomatous polyposis coli (APC) gene. Patients with FAP develop up to thousands of colorectal adenomas as well as lesions in the upper GI tract. In FAP, the upper digestive lesions include gastric fundic gland polyps (FGPs), antrum adenomas, duodenal or small intestinal adenomas, and carcinoma. Patients, after colectomy, are still at significant risk for extracolonic malignancies. Advances in endoscope resolution and optical enhancement technologies allow endoscopists to provide assessments of benign and malignant polyps. For this reason, in the past decades, endoscopic resection techniques have become the first line of treatment in patients with polyps in the upper GI, whereby polyps and even early cancers can be successfully cured. In FAP patients, endoscopic ampullectomy appears to be a safe and effective way of treating patients with ampullary tumors. According to current indications, endoscopic retrograde cholangiopancreatography (ERCP) and stenting of the main pancreatic duct follow ampullectomy.

Comparison between application of platelet rich plasma and mucosal advancement flap in patients with high transsphincteric anal fistulas: a randomized control trial.

BACKGROUND: There is still a search for a standard method of therapy for high anal fistulas. The aim of this trial was a comparison between a modified two stage minimally invasive procedure, consisting of loose-seton placement with the subsequent application of platelet rich plasma with mucosal advancement flap for the treatment of high transsphincteric anal fistulas of crypto-glandular origin. METHODS: The study was designed as a prospective, randomized trial including 96 patients. Curettage of fistulous tracts, and loose-seton placement was performed in those patients with active inflammation, and if the diameter of a fistulous tract exceeded 3 mm. Afterwards, the patients were randomly assigned to either the PRP group or MAF group, consisting of 49 patients, and 47 patients, respectively. RESULTS: There was no significant statistical difference (p = 0.152) between both investigated groups of patients regarding closure of fistulas since it was achieved in 35 (71.43%) patients from group I, compared to 27 (57.45%) patients from group II. The diameter of fistulous tracts below 4 mm exerted a significant impact (p < 0.001) on the healing process after PRP application because fistulas with the narrow tracts were closed in 34 (87.18%) patients, whereas a wider fistula was healed in 1 (10%) patient. CONCLUSION: The local application of PRP in high, unbranched, and with narrow tracts trans-sphincteric anal fistulas of crypto-glandular origin, following loose-seton drainage is an effective, simple, and a safe method of therapy with a low rate of morbidity.

Application of platelet-rich plasma in rectovaginal fistulas in the patients with ulcerative colitis.

BACKGROUND: There is a need for other than surgical methods of therapy for small and low rectovaginal fistulas (RVF) in the course of inflammatory bowel diseases (IBD), such as application of fibrin sealants, stem cells, biological therapy, or platelet-rich plasma. The aim of this study was to evaluate the results of the treatment after local application of PRP in aforementioned fistulas, exclusively in the patients with ulcerative colitis (UC). PATIENTS AND METHODS: Medical records of 13 patients with small and low-lying, active RVF in the course of UC, and after restorative proctocolectomy for UC were evaluated. Curettage of fistulous tracts was performed with the following application of PRP in all patients. RESULTS: Complete closure of RVF was achieved after the first injection in 4 patients, 3 women healed their fistulas following the second application, and two of them closed RVF after 3 injections. To sum up, the complete closure of RVF was achieved in 9 (69%) patients. Fistulas remained closed from 6 to 12 months. CONCLUSIONS: The application of PRP in small, low, and recurrent IBD anal fistulas is effective, simple, and safe with an acceptable rate of healing. This therapy might also precede any further, surgical methods of treatment.

The Role of Diagnostic Management in COVID-19 Screening of Asymptomatic Patients Admitted for Elective Surgery.

BACKGROUND: Due to the high risk of COVID-19 transmission by asymptomatic patients, the aim of this study was to evaluate chest computed tomography (CT) and blood differential test as an additional COVID-19 screening tool for patients undergoing elective or urgent surgery. PATIENTS AND METHODS: The preoperative assessment of 118 patients hospitalized from June to July 2020 included real-time reverse transcriptase polymerase chain reaction RNA test before elective surgery or rapid antigen test in emergency patients. The diagnostics were supplemented by chest CT and a complete blood count with a blood smear in all patients. RESULTS: None of the hospitalized patients had molecular, serological or radiographic symptoms of COVID-19 infection. The chest CT revealed non-COVID-19 pathologies in a total of 48 patients. Leukocytosis and lymphopenia were typical of emergency patients. CONCLUSION: Routine chest CT scans have no benefit in screening for potential COVID-19 changes in asymptomatic patients. Blood differential tests are readily available, which makes them more helpful in COVID-19 screening.

ASSESSMENT OF RECURRENT ANAL FISTULAS TREATMENT WITH PLATELET-RICH PLASMA.

BACKGROUND: Surgical treatment of recurrent anal fistulas can lead to numerous complications, including fecal incontinence. Therefore, sphincter preserving techniques are gaining more popularity. OBJECTIVE: The aim of the study was to assess effectiveness of platelet-rich plasma (PRP) therapy in the patients with recurrent cryptoglandular anal fistulas. METHODS: A cohort of 18 patients with anal fistulas was enrolled into a preliminary and prospective trial. They were divided into two groups consisting of eight and ten patients respectively. PRP was injected locally in all patients, however in the group II it was applied after 7 days drainage of fistulas with polyurethane foam or negative pressure wound therapy. On average, three doses of PRP were administered, but with the opportunity to double the number of applications if it was clinically justified. The patients were evaluated in an out-patient department after fortnight and then in 1, 6, and 12 months following the last PRP application. RESULTS: Anal fistulas were closed in 4 (50%) patients from the group I and in 7 (70%) patients form the group II. Although, the difference between both groups was not statistically significant, PRP therapy should be preceded with fistulous tract drainage in all patients. Summarizing, that successful result was achieved in 11 (60%) patients from the entire group of 18 participants. CONCLUSION: The rate of recurrent cryptoglandular anal fistulas closure reaching 60%, after topical treatment with PRP, exceeds the results of other sphincter-saving methods of treatment. Therefore, it might become a novel method of anal fistulas therapy.

Avaliação do tratamento recorrente de fístulas anais com plasma rico em plaquetas / Assessment of recurrent anal fistulas treatment with platelet-rich plasma

ABSTRACT BACKGROUND: Surgical treatment of recurrent anal fistulas can lead to numerous complications, including fecal incontinence. Therefore, sphincter preserving techniques are gaining more popularity. OBJECTIVE: The aim of the study was to assess effectiveness of platelet-rich plasma (PRP) therapy in the patients with recurrent cryptoglandular anal fistulas. METHODS: A cohort of 18 patients with anal fistulas was enrolled into a preliminary and prospective trial. They were divided into two groups consisting of eight and ten patients respectively. PRP was injected locally in all patients, however in the group II it was applied after 7 days drainage of fistulas with polyurethane foam or negative pressure wound therapy. On average, three doses of PRP were administered, but with the opportunity to double the number of applications if it was clinically justified. The patients were evaluated in an out-patient department after fortnight and then in 1, 6, and 12 months following the last PRP application. RESULTS: Anal fistulas were closed in 4 (50%) patients from the group I and in 7 (70%) patients form the group II. Although, the difference between both groups was not statistically significant, PRP therapy should be preceded with fistulous tract drainage in all patients. Summarizing, that successful result was achieved in 11 (60%) patients from the entire group of 18 participants. CONCLUSION: The rate of recurrent cryptoglandular anal fistulas closure reaching 60%, after topical treatment with PRP, exceeds the results of other sphincter-saving methods of treatment. Therefore, it might become a novel method of anal fistulas therapy.

RESUMO CONTEXTO: O tratamento cirúrgico de fístulas anais recorrentes pode levar a inúmeras complicações, incluindo incontinência fecal. Portanto, as técnicas de preservação do esfíncter estão ganhando mais popularidade. OBJETIVO: O objetivo do estudo foi avaliar a eficácia da terapia de plasma rico em plaquetas (PRP) nos pacientes com fístulas anais criptoglandulares recorrentes. MÉTODOS: Uma coorte de 18 pacientes com fístulas anais foi inscrita em ensaio preliminar e prospectivo. Eles foram divididos em dois grupos compostos por 8 e 10 pacientes, respectivamente. PRP foi injetado localmente em todos os pacientes, porém no grupo II foi aplicado espuma de poliuretano ou terapia de feridas por pressão negativa após 7 dias de drenagem de fístulas. Em média, foram administradas três doses de PRP, mas com a oportunidade de dobrar o número de aplicações se fosse clinicamente justificado. Os pacientes foram avaliados em ambulatório após quinze dias e depois em 1, 6 e 12 meses após a última aplicação do PRP. RESULTADOS: As fístulas anais foram fechadas em 4 (50%) pacientes do grupo I e em 7 (70%) pacientes do grupo II. Embora a diferença entre ambos os grupos não tenha sido estatisticamente significante, a terapia PRP deve ser precedida de drenagem do trato fístulo em todos os pacientes. Resumindo, esse resultado bem-sucedido foi alcançado em 11 (60%) pacientes de todo o grupo de 18 participantes. CONCLUSÃO: A taxa de fechamento recorrente de fístulas anais criptoglandulares chegando a 60%, após tratamento tópico com PRP, excede os resultados de outros métodos de tratamento que preservam o esfíncter. Portanto, pode se tornar um novo método de terapia das fístulas anais.

Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence: A case report.

BACKGROUND: Esophagogastric leakage is one of the most severe postoperative complications. Partial disruption of the anastomosis, can be successfully treated with an endoscopic vacuum assisted closure (E-VAC). The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess. The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC. CASE SUMMARY: Two male patients developed a potentially life threatening esophagogastric leakage. Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction. Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears. Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances, and treatment of sepsis with appropriate antibiotics. CONCLUSION: Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy. Through individual approach it allows a more accurate assessment of healing.

Atypical and Life-threatening Crohn's Disease Following Colectomy: A Case Report.

Although Crohn's Disease (CD) usually occurs between the second and third decade of life, it also may develop in older adults. Treating elderly patients may be challenging due to other comorbidities, including diverticular disease or intestinal ischemia. PURPOSE: The purpose of this case study was to describe successful treatment of atypical and life-threatening CD due to enterocutaneous fistulas with short-bowel syndrome and multiorgan failure after partial colectomy. CASE REPORT: After an urgent colectomy for an inflammatory colon tumor, a 64-year-old woman with a history of CD and multiple comorbidities developed acute small bowel ischemia. Following an extended bowel resection, she developed a severe surgical site infection, entero- and gastrocutaneous fistulas, multiorgan failure, and short bowel syndrome. Her care included intensive medical and nutritional treatment as well as negative pressure wound therapy (NPWT) using continuous negative pressure of -80 mm Hg. She not only survived, but she also achieved complete wound closure and restoration of digestive tract continuity and metabolic control. She was discharged with a central venous catheter on total parenteral nutrition. CONCLUSION: In this case study, a good outcome was observed using intensive medical treatment, nutritional therapy, and conservative surgical treatment that included NPWT for a patient with CD and major comorbidities who developed postoperative complications.

The Impact of 0.9% NaCl on Mesothelial Cells After Intraperitoneal Lavage During Surgical Procedures.

BACKGROUND: Normal saline gained wide popularity in abdominal surgery as a basic compound used in intraoperative drainage of the peritoneal cavity. However, recent studies have revealed that saline solution is not quite biocompatible with the intraperitoneal enviroment and may promote peritoneal adhesions. OBJECTIVES: The aim of the study was to evaluate the function and viability of human mesothelial cells cultured in vitro in 0.9% NaCl solution from intraperitoneal lavage carried out during laparoscopic cholecytectomies. MATERIAL AND METHODS: The study included 40 consecutive patients suffering from gallstones who underwent laparoscopic cholecystectomy. Fluid was collected after intraperitoneal lavage during the surgical procedures. The samples obtained were used as a medium for in vitro incubation of primary human mesothelial cells. After 24 h the synthesis of interleukin 6 (IL-6), plasminogen activator inhibitor (PAI) and tissue plasminogen activator (tPA), as well as the index of cell proliferation were assessed in all the experimental groups. RESULTS: All the mesothelium cell cultures treated with fluid samples obtained ex vivo were characterized by elevated levels of IL-6. The highest concentrations of PAI-1 were found in groups of cells exposed to fluid with bile; similarly, tPA synthesis was extremely elevated in groups treaded with fluid containing bile and small amounts of hemolyzed blood. In contrast, cell proliferation was exceedingly high in 2 groups of cells placed in a standard culture medium and in 0.9% NaCl solution. CONCLUSIONS: Normal saline introduced into the abdominal cavity modifies the biological and physicochemical conditions of the intraperitoneal environment. The impact of 0.9% NaCl on mesothelial cells is manifested in destabilized tissue regeneration, which supposedly initiates adhesion formation.

Normal saline may promote formation of peritoneal adhesions.

BACKGROUND: Normal saline is commonly used for rinsing the abdominal cavity and many surgeons claim that it is not harmful to peritoneum. We found in patients treated with laparoscopic surgery, that mean 25% of the instilled fluid is not drained and dwells in the abdominal cavity. Therefore we evaluated changes of the saline biocompatibility during its dwell in the rats abdominal cavity. METHODS: In 10 anesthetized rats normal saline were instilled into the abdominal cavity and samples of the dwelling solution were collected every 30 minutes, for 4 hours. Inflammatory parameters and effect of the collected samples on in vitro cultured rats mesothelial cells were studied. RESULTS: Low pH of the saline was normalized, but number of cells and % of macrophages and eosinophils, as well as elastase activity and MCP-1 and TGF-ß concentration increased, proportionally to the dwell time. Fluid samples tested ex-vivo suppressed proliferation of the mesothelial cells and induced biphasic (stimulation/inhibition) effect on synthesis of MCP-1 in these cells. Similar pattern of release was observed for TF, whereas synthesis of t-PA in the mesothelial cells was strongly suppressed. CONCLUSIONS: Mesothelial cells exposed in vivo to normal saline dwelling in the abdominal cavity acquire properties which may accelerate formation of the peritoneal adhesions.

[Robotic surgery and NOTES--Natural Orifice Translumenal Endoscopic Surgery in treatment of cholelithiasis--revolution or failed conception]. / Robotyka medyczna i operacje NOTES--Natural Orifice Translumenal Endoscopic Surgery w leczeniu kamicy zólciowej--rewolucja czy slepa droga.

At the beginning of 90th years of the last century a laparoscopy technique initiated a new chapter in surgical treatment becoming the realistic alternative of classical laparotomies. Nowadays, after 20. years from first laparoscopic cholecystectomy new treatment methods such as Natural Orifice Translumenal Endoscopic Surgery (NOTES) and robotic surgery are gaining more and more great interest. The first robots created in the middle of 90 years were used only for keeping a camera and they were steered with voice, however with the development of technology was possible constructing precise machines, which were able to carry complicated procedures out (fundoplication, gastrectomy or colectomy), also from a long distance. At present two types of robots are being applied in the medical practice: da Vinci and Zeus. NOTES is a method that make possible to perform operations trough natural orifice of the body with an endoscope and appropriate instrumentation. Actually three fundamental ways of reaching the peritoneum are being used: through the stomach, through the rectum and through the vagina. Some authors tried also to use transbladder approach. The main advantage of the NOTES technique is a possibility of performing the procedure without necessity of cutting the abdominal wall, what decreases postoperative pain, eliminates the problem of an infecting wound, minimizes risk of postoperative hernias and reduces amount of postoperative adhesions. Problems related to the NOTES technique are mostly need of inventing new and better equipment, assurance tightness of the surgical access, development of an efficient antiseptic prophylaxis and also standardize learning methods. Dynamic development of the NOTES method allows overcoming some of these limitations by using innovative technical solutions and new systems e.g. TULA, NOTUS, ShapeLock, ViaCath, MAGS and many others. The aim of this study is a deep analysis of the recent technical solutions, rules of the therapy and schedules of management valid in the NOTES method and the robotic surgery suggested by the leading clinics. The article is also an attempt to answer the question if this new surgical procedures become as great revolution as laparoscopy.