NOTES: Current Status and New Horizons

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NOTES: Current Status and New Horizons Mouen A. Khashab, Anthony N. Kalloo Gastroenterology Volume 142, Issue 4, Pages 704-710.e1 (April 2012) DOI: 10.1053/j.gastro.2012.02.022 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 Submucosal tunneling technique for transesophageal mediastinoscopy. (A) saline/methylene blue solution is injected into the submucosa. (B) Needle knife mucosal/submucosal puncture. (C) Creation of submucosal space by blunt dissection and/or balloon dilation. (D) Off-site needle knife penetration of the muscularis propria with subsequent entry into the mediastinum (see inset). (E) Offset closure of muscular defect with overlying mucosal flap. Gastroenterology 2012 142, 704-710.e1DOI: (10.1053/j.gastro.2012.02.022) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 Fluoroscopic view of endoscopic vertebral bone biopsy. Gastroenterology 2012 142, 704-710.e1DOI: (10.1053/j.gastro.2012.02.022) Copyright © 2012 AGA Institute Terms and Conditions

Figure 3 Tissue expansion technique to facilitate dissection during NOTES as compared with laparoscopic resection. (A) NOTES cholecystectomy. (B) Laparoscopic cholecystectomy. (Ai) An endoscope is passed into the peritoneum through a transgastric approach and the gallbladder is visualized. (Aii) Gallbladder fossa is injected to “lift” gallbladder away from its bed. (Aiii) Subsequently, gallbladder is dissected using needle knife. (Bi) Several transabdominal trocars are placed. (Bii) Gallbladder is retracted away from its fossa before resection. (Biii) Laparoscopic resection of gallbladder after retraction. Gastroenterology 2012 142, 704-710.e1DOI: (10.1053/j.gastro.2012.02.022) Copyright © 2012 AGA Institute Terms and Conditions