Natural Orifice Surgery: Transdouglas Surgery—a New Concept

BACKGROUND: During the 20th century, laparoscopic procedures replaced most traditional abdominal operations and achieved high-quality standards. It seemed that the optimal surgical method had been achieved; however, a new concept, which might possibly become even safer and simpler is now being developed, the concept of Natural Orifice Surgery (NOS). The existing natural openings of the body started to be used for introduction of surgical instruments for diagnostic purposes and surgical procedures, avoiding penetrating the abdominal wall. Parallel to the American Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) group, is the New European Surgical Academy (NESA) established in Berlin on June 23, 2006. It is the first European-based NOS working group with participation of scientists and surgeons from different disciplines and countries. After the published experimental achievements had been presented and discussed, the working group decided to concentrate mainly on the transvaginal/transdouglas access in women. DATABASE: A new surgical instrument, the Transdouglas Endoscopic Device (TED) has been designed. This is a flexible multichannel instrument enabling single-entry surgical, urological, and gynecological operations. TED respects the anatomy of the pelvis. To get to the upper abdomen, an S-shaped device was designed, bending first to the front, and then backwards. For the lower abdomen, the U-shaped mode of the instrument was designed. The wide diameter of the device (35 mm) and its multichannel design enables simultaneous use of different instruments, therefore avoiding hybrid procedures. Various surgical and gynecological procedures have been successfully simulated, and the manufacturing of the device is in progress. Preclinical studies will start soon. CONCLUSIONS: Transvaginal/transdouglas surgery is expected to be a valid alternative to traditional endoscopic procedures in women. It seems that NOS will create a spectrum of innovative and high-quality procedures performed by an interdisciplinary team and will improve patient safety.