La chirurgie endoscopique transluminale par orifice naturel (NOTES) est un stade supplémentaire dans la chirurgie mini-invasive puisqu’elle permet aux chirurgiens de ne pratiquer aucune incision au niveau de la paroi abdominale.
Cette fois, l’accession à la cavité péritonéale se fait grâce à des endoscopes multicanaux, au travers de l'estomac ou du vagin qui sont « perforés » ; l’opération peut être effectuée en faisant passer des instruments spécialement conçus pour les canaux de travail de l'endoscope. Cette technique a été décrite pour des appendicectomies et des cholécystectomies. Le plus grand défi pour les NOTES est la fermeture de l’orifice créé dans l'estomac ou le vagin. Cette voie d’abord n'a été que très peu utilisée par les chirurgiens pédiatres en raison du peu d’indications en chirurgie programmée. Récemment, un article rapporte un abaissement rectal trans-anal par NOTES pour un enfant présentant une maladie de Hirschsprung, permettant la mobilisation du côlon sigmoïde sans incision abdominale (87). D'autres se sont penchés sur des techniques hybrides combinant NOTES et mini laparoscopie (88), pour le traitement de l'atrésie de l'œsophage ou encore pour d'autres utilisations. Chez l’enfant, on en est toujours au stade expérimental.
Après cette large introduction sur la vidéochirurgie, nous allons voir plus en détail certaines applications que nous avons travaillées dans les différents domaines de la chirurgie pédiatrique, en commençant par la chirurgie néonatale.
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