The Risks of NOTES Surgery
The risks of the natural orifice surgery include the internal NOTES incision becoming inflamed, infected or even separating without the patient being aware of the problem. During the recovery from a surgery with an incision made in the skin, the incision can be inspected by looking under the dressing. At most, a mirror may be needed to visualize an incision. This is not the case after a NOTES procedure. Unlike a typical incision, an incision made for the NOTES procedure would be located in the stomach, vagina or rectum. A visual inspection of the incision would require a visit to the doctor.
Like any surgery, bleeding is a risk, and in the case of a vaginal NOTES procedure, uncontrolled bleeding could hypothetically lead to infertility if the bleeding is severe and the treatment is hysterectomy or a procedure that causes significant scarring. An incision that leaks can lead to peritonitis, a serious and painful inflammation of the abdominal tissue that results in infection.
Some critics of the procedure feel that it is unwise and unnecessary to place an incision in an organ that is normal and functioning well. For example, inserting instruments into the mouth and down the esophagus into the stomach requires an incision in the stomach to perform the procedure on an adjoining structure. The more standard procedure would place incisions in the abdomen, through the skin, tissue and muscle, totally avoiding healthy organs.
Another argument is that the natural orifices, which include the mouth, the vagina, and the rectum, are far dirtier than skin that is prepped for a surgical incision. The fear is that this could increase the risk of surgical infections, due to the bacteria naturally present in these areas.
The NOTES procedure is still under investigation, as more of these surgeries are performed, more is expected to be learned about the risks associated with this type of operation.
CIMIT Program: Natural Orifice Translumenal Endoscopic Surgery. CIMIT Programs. Accessed March 2011. http://www.wbur.org/2009/06/22/orifice-surgery
sub>Natural Orifice Surgery: Initial Clinical Experience. Santiago Horgan, et al, Accessed March 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695868/
NOTES. Northwestern Memorial Hospital. Accessed March 2011. http://www.nmh.org/nm/natural+orifice+translumenal+endoscopic+surgery+notes