{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.natural-orifice-translumenal-endoscopic-surgery","code":"thing-q1961340","url":"https://ver.cy/models/thing/q1961340/","name":"natural orifice translumenal endoscopic surgery","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Information and virtual systems","entryKind":"thing","plane":"INF","domain":["INF.KNW"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive surgical approach in which instruments enter through a natural body opening and cross the wall of an internal hollow organ to reach and operate within another body cavity.","purpose":"Enable an agent to recognise natural orifice translumenal endoscopic surgery (NOTES), distinguish its variants, and assess what evidence and capabilities support a proposed application.","scope":{"in":["Natural-orifice entry with intentional translumenal access to an operative target beyond the entry lumen, consistent with the historical [ASGE definition](https://www.asge.org/home/resources/publications/guidelines/appropriate-use-of-gi-endoscopy).","Classification by entry orifice, traversed wall, target compartment and surgical objective.","Distinctions between pure NOTES, hybrid NOTES and related endoscopic approaches.","Access, visualisation, tissue manipulation, closure and rescue capabilities required by each variant.","Procedure-specific evidence, patient-selection criteria and institutional adoption requirements."],"out":["Individual patient records, clinical consent decisions and operative instructions.","Disease models and the independent justification for treating a particular condition.","Device engineering, manufacturing specifications and individual product approvals.","Conventional intraluminal endoscopy and abdominal-port surgery except as boundary cases or comparators.","Practitioner identities, professional organisations and publications as standalone entities."],"boundaries":[]},"distinguishingFeatures":["Natural-orifice entry alone is insufficient: identify the wall crossed and the operative space reached beyond the entry lumen.","Distinguish natural-orifice access used to perform surgery from natural-orifice specimen extraction following surgery performed through other access routes.","Record whether transabdominal ports contribute to access, visualisation or manipulation before applying a pure or hybrid label.","Distinguish an intended translumenal access opening from an accidental perforation during endoscopy.","Treat NOTES as a family of approaches spanning procedures and specialties, rather than a single operation or a synonym for all minimally invasive surgery."],"structure":{"bundles":[{"id":"identity-and-boundaries","name":"Identity and boundaries","description":"Establishes what counts as NOTES and which neighbouring techniques remain distinct.","layers":[{"id":"defining-access","name":"Defining access","description":"Tests the anatomical and operative conditions for inclusion.","findings":[{"id":"translumenal-operative-access","name":"Translumenal operative access","description":"Record the entry orifice, intentional wall crossing and operative target as separate facts.","questions":[{"text":"Which natural orifice and internal wall form the operative access pathway, and which space is reached?","id":"translumenal-operative-access-q01","kind":"definition"},{"text":"Does surgery use that pathway, or is it used only for specimen extraction?","id":"translumenal-operative-access-q02","kind":"boundary"}]}]},{"id":"classification-conventions","name":"Classification conventions","description":"Makes terminology and disputed inclusions traceable.","findings":[{"id":"variant-membership","name":"Variant membership","description":"Assign pure, hybrid or disputed membership under a named convention rather than relying on a procedure's marketing label.","questions":[{"text":"Which dated society statement, review or classification defines the variant label being used?","id":"variant-membership-q01","kind":"provenance"},{"text":"How does that convention treat abdominal assistance, transvaginal approaches and submucosal tunnel procedures?","id":"variant-membership-q02","kind":"boundary"}]}]}]},{"id":"anatomy-and-application","name":"Anatomy and application","description":"Connects the access pathway to the proposed operation and its selection constraints.","layers":[{"id":"route-target-fit","name":"Route and target fit","description":"Describes the anatomical relationship between entry and operative target.","findings":[{"id":"anatomical-reach","name":"Anatomical reach","description":"Record evidence that the target can be reached and operated on through the specified route.","questions":[{"text":"Which target organ and operative objective are associated with this access route?","id":"anatomical-reach-q01","kind":"definition"},{"text":"What evidence identifies limits imposed by orientation, working distance, intervening anatomy or previous surgery?","id":"anatomical-reach-q02","kind":"provenance"}]}]},{"id":"selection-and-alternatives","name":"Selection and alternatives","description":"Records application-specific selection criteria and relevant alternative approaches.","findings":[{"id":"selection-envelope","name":"Selection envelope","description":"Keep study eligibility criteria distinct from validated contraindications and individual clinical decisions.","questions":[{"text":"Which route-specific selection constraints are supported by evidence, and which were merely exclusions in a study?","id":"selection-envelope-q01","kind":"boundary"},{"text":"Which alternative approach treats the same indication and should be considered in specialist review?","id":"selection-envelope-q02","kind":"action"}]}]}]},{"id":"operative-capabilities-and-access-integrity","name":"Operative capabilities and access integrity","description":"Describes the functional requirements for operating through a natural-orifice pathway and managing its wall opening.","layers":[{"id":"working-platform","name":"Working platform","description":"Relates instrumentation and assistance to the operative tasks they enable.","findings":[{"id":"task-capability-coverage","name":"Task capability coverage","description":"Map visualisation, orientation, retraction, instrument coordination and tissue control to demonstrated platform capabilities.","questions":[{"text":"Which required surgical tasks have been demonstrated with the proposed platform and route?","id":"task-capability-coverage-q01","kind":"provenance"},{"text":"Which tasks require an additional port or other assistance, and how does that affect the variant classification?","id":"task-capability-coverage-q02","kind":"boundary"}]}]},{"id":"wall-opening-and-rescue","name":"Wall opening and rescue","description":"Captures access-site integrity, contamination control and escalation requirements without prescribing operative steps.","findings":[{"id":"access-integrity-assurance","name":"Access integrity assurance","description":"Record how closure performance and access-related failures are evaluated for the particular tissue and route.","questions":[{"text":"What evidence evaluates closure integrity, leakage and infection for this access route and closure method?","id":"access-integrity-assurance-q01","kind":"measurement"},{"text":"What documented escalation capability is required if access, haemostasis or closure cannot be secured?","id":"access-integrity-assurance-q02","kind":"action"}]}]}]},{"id":"comparative-evidence-and-outcomes","name":"Comparative evidence and outcomes","description":"Supports judgments about feasibility, benefits and harms without generalising across unlike applications.","layers":[{"id":"evidence-applicability","name":"Evidence applicability","description":"Locates each claim within its actual population, technique and study design.","findings":[{"id":"claim-support","name":"Claim support","description":"Separate preclinical feasibility, human case experience and comparative clinical evidence.","questions":[{"text":"Is the supporting evidence preclinical, an uncontrolled clinical series or a comparative study?","id":"claim-support-q01","kind":"provenance"},{"text":"Do the studied route, operation, platform and operator experience match the application being assessed?","id":"claim-support-q02","kind":"boundary"}]}]},{"id":"benefit-harm-comparison","name":"Benefit and harm comparison","description":"Defines comparable outcome measures and adequate follow-up.","findings":[{"id":"outcome-accounting","name":"Outcome accounting","description":"Include completion, additional access, complications, recovery and route-specific patient-reported outcomes.","questions":[{"text":"What are the denominators, follow-up periods and definitions for completion, conversion and adverse events?","id":"outcome-accounting-q01","kind":"measurement"},{"text":"Against the same operation by an alternative approach, what evidence supports differences in pain, recovery, quality of life or route-specific functional effects?","id":"outcome-accounting-q02","kind":"measurement"}]}]}]},{"id":"clinical-adoption-and-governance","name":"Clinical adoption and governance","description":"Tracks the conditions under which a specific NOTES application can be considered by a clinical institution.","layers":[{"id":"dated-adoption-status","name":"Dated adoption status","description":"Qualifies maturity and institutional guidance by procedure, place and time.","findings":[{"id":"application-status","name":"Application status","description":"Record current guidance and local status without extending one application's acceptance to the whole family.","questions":[{"text":"Which dated professional guidance or institutional policy addresses this route and indication in the relevant jurisdiction?","id":"application-status-q01","kind":"provenance"},{"text":"Does the proposed use fall within established local practice or require a research or innovation review pathway?","id":"application-status-q02","kind":"action"}]}]},{"id":"team-readiness-and-consent","name":"Team readiness and consent","description":"Records application-specific competence, support and disclosure requirements.","findings":[{"id":"readiness-evidence","name":"Readiness evidence","description":"Connect team capability and patient information to the actual route, uncertainty and possibility of additional access.","questions":[{"text":"What documented training, supervision and rescue support does the institution require for this application?","id":"readiness-evidence-q01","kind":"action"},{"text":"Which route-specific effects, evidence limitations, alternatives and possibilities of conversion must its consent process address?","id":"readiness-evidence-q02","kind":"action"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of natural orifice translumenal endoscopic surgery this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of natural orifice translumenal endoscopic surgery this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of natural orifice translumenal endoscopic surgery this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-measurements","name":"Typical measurements","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these typical measurements hold for the sense of natural orifice translumenal endoscopic surgery this model covers, and on what evidence?","id":"evidence-measurements-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of natural orifice translumenal endoscopic surgery this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of natural orifice translumenal endoscopic surgery this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain the NOTES approach, its claimed benefits and its limits, citing surgical literature.","Distinguish experimental NOTES procedures from established surgery."],"mustNot":["Present the approach as standard care where it is still investigational.","Assist or guide any surgical step outside a qualified team and approved setting.","Overstate benefits or understate risks such as leaks and infection.","Share patients' operative records without consent."],"requiresHuman":["Any decision on whether a patient should have a procedure.","Enrolling patients in a trial of the approach."]},"ethics":{"considerations":["New surgical approaches need informed consent and honest reporting of risk.","Hype can push patients toward unproven procedures."],"affectedParties":["Patients","Surgeons","Trial participants"]},"owners":{"steward":"Nobody owns the approach; the surgical team and hospital answer for each procedure.","roles":[],"masterSystems":[]},"relations":[{"target":"Q71713580","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.natural-orifice-translumenal-endoscopic-surgery","Wikidata: Q1961340 (https://www.wikidata.org/wiki/Q1961340)"]},"properties":{"applicability":"not-applicable","items":["Terminology convention: Defining source, issuing body, publication date and included or excluded techniques","Access route: Entry orifice, traversed wall and destination compartment; multiple routes permitted","Access configuration: Pure NOTES; hybrid NOTES; disputed classification; insufficiently described","Surgical application: Target organ, intended operation and indication linked to their own models","Platform capabilities: Documented access, imaging, retraction, manipulation, haemostasis, closure and rescue capabilities","Clinical adoption status: Preclinical; clinical investigation; restricted clinical use; established for a specified indication; unresolved, each dated and jurisdiction-specific","Completion without additional access: Percentage of attempted cases, with denominator and definition of additional access","Access-related adverse outcomes: Event counts and percentages with severity, attribution and follow-up interval"]},"recognition":{"applicability":"not-applicable","items":[]},"capabilities":{"applicability":"required","items":["Classify a described approach using its documented anatomical route and assistance configuration.","Identify missing evidence about access, closure or rescue before an application undergoes clinical review.","Compare outcomes for matching operations while separating routes, platforms and operator experience.","Link a proposed application to relevant technical capabilities, governance records and specialist review.","Flag claims such as scarless or less invasive when their definitions or supporting comparisons are absent."]},"hazards":{"applicability":"required","items":["Failure of internal access-site closure can cause leakage and serious infection.","Instruments can injure adjacent organs or blood vessels.","Limited visualization or access can prevent completion and require a different surgical approach.","Inadequate device processing can transmit infection."]},"interfaces":{"applicability":"required","items":["ISO 14971, issued by the International Organization for Standardization, specifies risk management for medical devices, including devices used in this approach.","ISO 17664-1, issued by the International Organization for Standardization, addresses processing information supplied by manufacturers for critical and semi-critical medical devices, including applicable reusable surgical instruments."]},"context":{"applicability":"required","items":["This surgical approach is used in selected specialist clinical settings to reach an internal body cavity through a natural opening and an internal organ wall.","Its suitability depends on the planned operation, patient characteristics, available evidence and the clinical team's capabilities."]}},"sources":[{"title":"Wikidata item Q1961340: natural orifice translumenal endoscopic surgery","url":"https://www.wikidata.org/wiki/Q1961340","note":"identity and sense of the item"},{"title":"Wikipedia: Natural orifice transluminal endoscopic surgery","url":"https://en.wikipedia.org/wiki/Natural_orifice_transluminal_endoscopic_surgery","note":"general description of the item"}],"openQuestions":["Which contemporary convention should govern inclusion of vNOTES, submucosal tunnelling procedures and other techniques described as NOTES derivatives?","Which route-and-indication combinations currently have comparative evidence sufficient to support clinical adoption, and in which jurisdictions?","Which closure-integrity and contamination-control outcomes can be compared across routes without concealing anatomical differences?","How complete is long-term evidence on access-site complications and route-specific sexual, reproductive, urinary or bowel function?","Which recognised indexing or classification schemes place NOTES as a technique family, and should the registry's INF.KNW placement link to a separate operative-activity model?"],"resources":{"spec":"/models/things/publications/thing-q1961340/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q1961340/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T11:32:53Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"not-applicable","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:28+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane INF: no invented physical properties.","interaction.recognition":"This is a surgical approach rather than a physical object with an intrinsic visual appearance."},"score":1.0}}