Training and Credentialing in NOTES (Natural Orifice Translumenal Endoscopic Surgery)

摘要

NOTES (Natural Orifice Translumenal Endoscopic Surgery) remains a largely experimental technique with scattered early case reports and a series showing safe and efficacious implementation. Most of these reports revolve around transvaginal cholecystectomy, with rigid and flexible endoscopic instrumentation utilized. The conundrum of how to train surgeons in this evolving area remains a vexing problem. Animate labs remain the hallmark of training for new procedures but are expensive and require close contact with industry professionals to help supply the necessary equipment for NOTES procedures. Courses are held by societies and universities and can be a useful opportunity for training. Virtual reality simulators can be a potential avenue for skill acquisition, but these are also costly and early in development. Multidisciplinary teams of surgeons, gastroenterologists, and gynecologists remain a recommended concept in the development of a new NOTES program. While credentialing remains a local issue, Institutional Research Board approval should still be entertained before beginning NOTES procedures.