ZenToks Publication

Chapter 17

Natural Orifice Transluminal Endoscopic Surgery (NOTES) Appendectomy: Review

Abstract/Preface

Acute appendicitis continues to be one of the most prevalent surgical emergencies globally, traditionally addressed through open or laparoscopic appendectomy. In the past two decades, minimally invasive techniques have advanced considerably, leading to the development of Natural Orifice Transluminal Endoscopic Surgery (NOTES). NOTES: Appendectomy is an innovative technique that avoids abdominal incisions by accessing the peritoneal cavity through natural orifices, such as the trans gastric or transvaginal routes. This review aims to consolidate current evidence on NOTES appendectomy for managing acute uncomplicated appendicitis, with a focus on its feasibility, safety, clinical outcomes, advantages, limitations, and prospects. The existing literature indicates that NOTES appendectomy is technically feasible and offers potential benefits, including reduced postoperative pain, enhanced cosmetic outcomes, and expedited recovery. Nonetheless, challenges such as technical complexity, infection risk, limited instrumentation, and the learning curve remain. Although hybrid NOTES techniques, which incorporate laparoscopic assistance, have demonstrated promising results, pure NOTES appendectomy is still largely experimental. This chapter underscores the current status of NOTES appendectomy and stresses the necessity for standardized protocols and long-term outcome assessments.