• Alberto Arezzo, Carsten Zornig, Hamid Mofid, Karl-Hermann Fuchs, Wolfram Breithaupt, José Noguera, Georg Kaehler, Richard Magdeburg, Silvana Perretta, Bernard Dallemagne, Jacques Marescaux, Catalin Copaescu, Florin Graur, Andrei Szasz, Antonello Forgione, Raffaele Pugliese, Gerhard Buess, Hemanga K Bhattacharjee, Giuseppe Navarra, Mario Godina, Kirill Shishin, and Mario Morino.
• Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy. alberto.arezzo@unito.it
• Surg Endosc. 2013 Sep 1; 27 (9): 3073-84.

BackgroundThe 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.MethodsThe ECR was designed as a voluntary database with online access. All members of the European Society for Gastrointestinal Endoscopy and the European Association for Endoscopic Surgery were requested to participate in the registry. Demographic and therapy data as well as data on the postoperative course are recorded in the ECR in an anonymous way.ResultsA total of 533 patients who underwent NOTES procedures were included in the study. Four different hybrid techniques for 435 cholecystectomies were described, registering postoperative complications in 2.8% of patients, addition of a single trocar in 5.3%, and conversions to laparoscopy in 0.5%. Both flexible endoscopic and rigid laparoscopic cholecystectomy techniques proved to be safe and effective with minor differences. There was a shorter operative time in the rigid laparoscopic group. Thirty-three appendectomies were reported by transgastric and transvaginal techniques, with transvaginal techniques scoring shorter operative time and hospital stay, but with a frequent need to add more trocars. Overall complications occurred in 14.7% of patients but they did not differ significantly among the different techniques. One transvaginal and 31 transanal sigmoidectomies were included for prolapse and diverticulitis, with four postoperative complications (12.5%), but none needing further treatment. Twenty peroral esophageal myotomies were included with three postoperative complications (15.0%), but none needing further treatment.ConclusionsFive years since the introduction of NOTES into clinical practice, hybrid techniques have gained considerable clinical application. Several NOTES hybrid cholecystectomy and appendectomy techniques are practicable and safe alternatives to laparoscopic procedures. Also, sigmoidectomies and peroral esophageal myotomies were described, proving feasibility and safety. Nevertheless, the real benefit of NOTES for patients still needs to be assessed.

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