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NOTES for NOTES: How Conventional Endoscopic Instruments Work for Endoabdominal Surgery
Luca Milone2, Marc Bessler2, Michael Smith1, Evran Durak2, Nancy Hogle2, Dennis L. Fowler2, Peter D. Stevens*1
1Medicine-GI, Columbia University Medical Center, New York, NY; 2Surgery, Columbia University Medical Cener, New York, NY

Notes is the new frontier for abdominal surgery. It requires endoscopists and surgeons to translate and combine their skills to maximize efficiency. Described here is how flexible endoscopic instruments can best be used during NOTES procedure. We used several flexible endoscopic instruments to accomplish various surgical skills such as: grasping, dissecting, running the bowel and closing small vessels. We realized that for some surgical skills endoscopic instruments were surprisingly useful while for others totally useless. Even as this is a big step forward toward endoluminal surgery, further device development is essential for the success of NOTES.

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