Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Natural Orifice Transluminal Endoscopic Surgery (NOTES): Current Status and Future Prospects

Natural Orifice Transluminal Endoscopic Surgery (NOTES): 최신 동향과 전망

  • Kim, Yong-Sik (Department of Internal Medicine, Korea University College of Medicine) ;
  • Chun, Hoon-Jai (Department of Internal Medicine, Korea University College of Medicine)
  • 김용식 (고려대학교 의과대학 내과학교실) ;
  • 전훈재 (고려대학교 의과대학 내과학교실)
  • Received : 2010.09.02
  • Accepted : 2010.09.15
  • Published : 2010.09.30
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Abstract

The attempt to observe intraperitoneal organs with an endoscope using a transgastric approach in 2004 by Kalloo et al. heralded the commencement of a new era in endoscopy, which has led to the introduction of natural orifice transluminal endoscopic surgery (NOTES). NOTES has the potential to become an integral part of the field of medicine. So far, many techniques using NOTES have been reported through animal experiments, using diverse apparatus such as suture devices and multitasking platforms. Since a cholecystectomy was performed via a transvaginal route in a human in 2007 by Marescaux et al. from France, clinical experience is also growing. However, much has yet to be learned and many obstacles must be overcome before NOTES can be applied to clinical practice. As mentioned in the whitepaper by NOSCAR in 2005, secure sealing of the orifice after the procedure, development of appropriate instruments for the procedures, selection of suitable access to the peritoneal cavity, and adequate measures to prevent infection and complications still remain unresolved problems. Nevertheless, just as laparoscopic surgery has eventually been recognized as an important surgical technique, NOTES is expected to occupy an important place as an invaluable therapeutic modality for managing gastrointestinal disorders in the near future.

2004년 Kalloo 등에 의해 경위경로 내시경 복강 내 검사가 보고된 이후 NOTES (natural orifice transluminal endoscopic surgery)는 의학의 새로운 영역으로 자리잡고 발전해 왔다. 현재까지 NOTES를 이용한 많은 술기들이 동물실험을 통해 보고되었으며, 봉합기기 또는 다기능 내시경과 같은 NOTES 시술을 위한 새로운 기기들이 개발되었다. 또한 2007년 프랑스의 Marescaux 등이 사람을 대상으로 경질경로 담낭절제술을 시행한 이래 임상에서의 경험도 점차 증가하고 있는 추세이다. 그러나 NOTES가 실제 임상에 적용되기까지는 가야 할 길이 아직도 멀다. 2005년 NOSCAR의 백서에서 언급되었던 복강 내로 진입하기 위해 만든 개방창의 안전한 봉합이나, 복강 내 시술에 적합한 기기의 개발, 적절한 접근경로의 선택, 감염 및 합병증의 예방 등의 문제점들이 대부분 아직도 완전히 해결되지 않고 있다. 하지만 복강경 수술이 정착되는데 많은 어려움이 있었지만 결국 중요한 외과 수술법으로 인정받은 것과 같이 NOTES도 새로운 기기와 시술법의 개발을 통해 미래에 소화기질환의 치료에 중요한 자리를 차지할 것으로 기대한다.

Keywords

References

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