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Diagnostic and Therapeutic Endoscopy
Volume 2011 (2011), Article ID 245175, 8 pages
Review Article

Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base

1Department of Biosurgery and Surgical Technology, Academic Surgical Unit, Imperial College London, St.Mary's Hospital, South Wharf Rd, Paddington W2 1NY, UK
2Department of Interventional Endoscopy, Imperial College London, St.Mary's Hospital, South Wharf Rd, Paddington W2 1NY, UK
3Institute of Biomedical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK

Received 31 January 2011; Accepted 2 May 2011

Academic Editor: Spiros D. Ladas

Copyright © 2011 Mikael H. Sodergren et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Appropriate prevention of infection is a key area of research in natural orifice translumenal endoscopic surgery (NOTES), as identified by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR). Methods. A review of the literature was conducted evaluating the evidence base for access orifice preparation/treatment in NOTES procedures in the context of infectious complications. Recommendations based on the Oxford Centre for Evidence-Based Medicine guidelines were made. Results. The most robust evidence includes several experimental randomised controlled trials assessing infectious complications in the transgastric approach to NOTES. Transvaginal procedures are long established for accessing the peritoneal cavity following disinfection with antiseptic. Only experimental case series for transcolonic and transvesical approaches are described. Conclusion. Grade C recommendation requiring no preoperative preparation can be made for the transgastric approach. Antiseptic irrigation is recommended for transvaginal (grade C) NOTES access, as is current practice. Further human trials need to be conducted to corroborate the current evidence base for transgastric closure. It is important that future trials are conducted in a methodologically robust fashion, with emphasis on clinical outcomes and standardisation of enterotomy closure and postoperative therapy.