Single-Access Surgery: Less Is More?

  • Tahar Benhidjeb
  • Michael Stark
  • Jakob R. Izbicki
  • Oliver Mann


Laparoscopic surgery achieved high standards during the twentieth century. It is associated with lower morbidity, less pain, faster recovery, and a shorter hospital stay than open surgery. Is it, despite this achievement, still possible to make abdominal surgery simpler and safer, because it is the goal of every surgeon to minimize patient morbidity while maximizing the beneficial outcomes of the planned procedure? Most of the discomfort and complications associated with open and laparoscopic surgery are caused by the abdominal incisions: The longer is the incision, the stronger is the pain intensity and the higher is the risk for wound infection and hernia. To avoid this, it is necessary to perform surgical procedures without cutting the surface of the body and use natural openings as an entry to the abdomen or other parts of the body. Theoretical advantages of this natural orifice surgery (NOS) include less invasiveness by eliminating abdominal incisions, postoperative abdominal wall pain, wound infection, and hernia. Anthony Kalloo was the first to report an experimental transgastric peritoneoscopy [1]. When the gastroenterologists reached the intraperitoneal cavity through the wall of the stomach, the term natural orifice transluminal endoscopic surgery (NOTES) was introduced to describe procedures performed through natural body openings. As soon as other body openings became the target, this term became irrelevant because the vagina, for example, cannot be described as a lumen.


Laparoscopic Surgery Laparoscopic Appendectomy Conventional Laparoscopic Surgery Port Site Hernia Natural Orifice Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Tahar Benhidjeb
    • 1
    • 2
  • Michael Stark
    • 2
    • 3
  • Jakob R. Izbicki
    • 1
  • Oliver Mann
    • 1
  1. 1.Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.The New European Surgical Academy (NESA)BerlinGermany
  3. 3.The USP Hospital Palmaplanas of MallorcaMallorcaSpain

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