1,720,963 research outputs found
NOTES - International Status
No full textNOTES - International Status The clinical introduction of NOTES began only hesitantly, mostly due to negative experiences with the uncontrolled introduction of laparoscopic surgery in the early 1990s. To date, flexible endoscopic interventions within the abdomen have only been carried out in a limited number of cases due to a lack of proper instruments and poor knowledge about their use for parenchymal organs. However, over the past months, there has been remarkable progress and an exponential increase in clinical cases. In parallel, 'single port access surgery' has enabled access to the abdominal cavity with minimal trauma, minimal postoperative scars and the possibility of using long standard-laparoscopic instruments. Particularly in Germany, the number of transvaginal NOTES surgeries has increased considerably and will soon exceed 1,000. The present review reports experiences from the current literature as well as preliminary data which so far have only been presented at international congresses
Endoskopischer Verschluss eines intraoperativ perforierten Duodenaldivertikels mit einem „Over-the-Scope-Clip“ (OTSC) – Ein Fallbericht
No full textA 75-year-old multimorbid patient was referred to our department because of a suspected bile leak 4 days after a difficult "conversion" cholecystectomy. Multiple adhesions after prior right hemicolectomy and a deep discharge of the cystic duct into the common bile duct close to a diverticulum were found intraoperatively ERCP revealed an 8 mm linear defect at the bottom of a 4 x 2 cm duodenal diverticulum, most probably due to complex prior surgery. In accordance with the operating surgeons the defect was closed endoscopically using a "over-the-scope-clip" system (OTSC
"NOTES" - A Perspective for Gastrointestinal Medicine
No full textNOTES is an acronym for "Natural Orifice Transluminal Endoscopic Surgery" and represents endoscopic operations in sterile body cavities using the approach of natural orifices. In July 2005, a joint venture cooperation between the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for American Gastrointestinal Endoscopic Surgeons (SAGES), was founded to coordinate research activities in NOTES. The so called NOSCAR group, which stands for Natural Orifice Surgery Consortium for Assessment and Research, described in a white paper, agreements about animal and clinical research leading to a stepwise introduction of NOTES techniques. In 2003 and 2004, the first documented human NOTES procedures were performed in India. In March 2007, first hybrid transvaginal cholecystectomies were reported in the USA and France. The conversion of laparoscopic or minimal-invasive surgical operations to NOTES interventions requires competition with low percentages of morbidity and a mortality of far less than 1%, as associated with laparoscopic appendectomy or cholecystectomy. Potential advantages of NOTES procedures is an improved cosmetic result, potential less postoperative analgesic requirement, and a potential reduction in immunological response. The introduction of new surgical techniques, promotes the impulsive development of new instruments. Multimorbid, old and overweight patients may benefit from a reduced invasiveness of NOTES procedures. NOTES is still in early developmental steps and its role is still undetermined. it is important to stepwise introduce NOTES, to prevent a too rapid development leading to devastating complications of routine procedures, which may question the development of NOTES. The education of endoscopic NOTES interventionalists may require the introduction of a novel educational curriculum, which may lead to the development of a hybrid physician with the background of an interventional endoscopic gastroenterologist and minimally-invasive surgeon
Who Will Do NOTES in the Future? Gastroenterologist, Surgeon or Endoscopic Interventionalist?
No full textIt is Currently unpredictable how the NOTES interventionalist of the future will look like and which "mother discipline" he will originate from. Will it be more important to be a specialist and virtuoso in conventional flexible therapeutic endoscopy or will count a prior experience in a patho-anatomical field. Will mean endoscopic surgery in the abdomen = visceral surgery, endoscopic nephrectomy urology, tubal ligation = gynacology or will a limited scientific background focussed oil the intervention be sufficient similar to the skills of an interventional radiologist? Clinically gastroenterologists currently concentrate on endoscopic sewing, closure of perforations and endoscopic anastomoses. Surgeons currently concentrate on rigid "single port access" surgery transvaginally or transumbelically ("E-NOTES") until new instruments will be created by industry. A new curriculum for the "endoscopic interventionalist" should be brought oil its way soon
Technische Aspekte bei der endoskopischen Submukosa-Dissektion (ESD)
No full textWithin the last years endoscopic submucosal dissection (ESD) has established its role for the "en bloc" resection of even large mucosal precancerous or early cancerous lesions. However, there is little literature concerning devices and settings used for successful ESD. In the following article we give an overview on technical requirements and report on our own experiences over the last years
Diagnostic and interventional endoscopy in gastroenterology. From high-resolution chips and procedures for endoscopic resection to NOTES
No full textIn the past 10 years endoscopic diagnostics has benefited from technologies such as big chips, high-definition television (HDTV) and narrow band imaging (NBI). Video capsule endoscopy and double balloon enteroscopy have facilitated visualization of the entire small bowel. A number of studies on mucosal Barrett's and gastric cancers could prove that endoscopic mucosal resection (EMR) is oncologically equivalent to surgical resection when certain criteria are respected. However, EMR is less invasive and carries a substantially lower complication risk and mortality compared to surgery. Endoscopic submucosal dissection (ESD) facilitates en bloc resection with thorough histopathologic evaluation of the specimen, e. g. for mucosal lesions in the stomach and rectum. Endosonography (EUS) guided transgastric necrosectomy using a flexible gastroscope has set a milestone in the treatment of infected pancreatic necroses and has replaced open surgery in many centers. Natural orifice transluminal endoscopic surgery (NOTES) uses natural body openings as minimally invasive access to the abdomen and mediastinum. Interventional GI endoscopists and minimally invasive surgeons have profited from these innovations in micromechanics and microelectronics
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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