Lymph node navigation for pancreatic and biliary malignancy by NOTES

Background Lymph node navigation and accurate staging of liver or peritoneal metastasis leads to better selection of the optimal treatment for patients with pancreatic and biliary malignancy. Less invasive techniques of detecting lymph node metastasis and distant metastasis would be valuable. Natural orifice translumenal endoscopic surgery (NOTES) is a new, evolving concept of minimally invasive surgery that may be useful for the staging of intraabdominal cancers. Methods Review of the literature regarding peritoneoscopy and lymph node mapping and biopsy by NOTES. Results NOTES peritoneoscopy for accurate diagnosis and staging of intraabdominal cancers is already in clinical use, and two case reports have shown the safety and feasibility of this technique. Previous experimental studies have also shown that lymph node mapping by NOTES is technically feasible with the currently available devices. Conclusions With the continued development of the techniques and technology of NOTES, peritoneoscopy and lymph node mapping by NOTES may become an alternative method for preoperative staging for patients with pancreatic and biliary malignancy.