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In 2005, leaders of both SAGES (The Society of American Gastrointestinal and Endoscopic Surgeons) and ASGE (American Society for Gastrointestinal Endoscopy) recognized the potential importance of Natural Orifice Translumenal Endoscopic Surgery™ (NOTES™). As NOTES™ burst onto the scene it was apparent that this approach held potential for patients to derive a great deal of benefit in terms of diminished pain and a shorter convalescence, but also carried a risk of introducing new and potentially serious complications. Mindful of lessons learned from the rapid adoption of laparoscopic cholecystectomy as well as the inherently interdisciplinary nature of NOTES™, the governing boards of the two societies created a working group to consider the issues surrounding the development and introduction to clinical practice of NOTES™. This working group published its recommendations for NOTES™ development (Surg Endosc 2006;20(2):329-33, Gastrointest Endosc 2006;63(2):199-203.) as a White Paper that laid out not only the fundamental research problems to be solved, but also stated that all human NOTES™ procedures be performed under IRB oversight and that the results be recorded in a registry accessible to all SAGES and ASGE members so that they might learn from other therapists experiences.
What is NOSCAR?
Posted 08/24/2007
David W Rattner, MD; Robert Hawes, MD
Posted 08/24/2007
David W Rattner, MD; Robert Hawes, MD
The members of the original working group coined the acronym NOSCAR™ as one that would be appropriate for incisionless surgery. NOSCAR™ stands for the Natural Orifice Surgery Consortium for Assessment and Research™. The sponsoring societies have established a web domain www.NOSCAR.org for information exchange and also trademarked the name. SAGES and ASGE subsequently established a joint committee that oversees NOSCAR™ activities. NOSCAR™ held its first summit meeting in March 2006 at which time participants from surgery, gastroenterology, and industry developed research roadmaps for the eight fundamental challenges identified in the original White Paper. The attendance and enthusiasm as well as the perceived accomplishments at this meeting exceeded expectations. Based on consensus of the stakeholders at the meeting and with approval from the governing boards of the parent societies NOSCAR™ established a more formal structure.
The Research Subcommittee of NOSCAR™ is tasked with furthering the research mission of NOTES™. To date, 1.5 million dollars have been raised for research directed at the fundamental barriers to NOTES™. All SAGES and ASGE members have been invited to submit grant proposals. The proposals have been peer reviewed in a blinded fashion by the committee and the grants have been awarded. The list of awardees is posted on the NOSCAR™ web site.
The Registry Subcommittee of NOSCAR™ has been charged with developing a database registry to record the outcome of human NOTES™ procedures. This database was presented at the 2nd International NOTES™ Symposium in July in Boston. All teams performing NOTES™ or hybrid (NOTES™ with laparoscopic assistance) will be strongly encouraged to submit their cases to the registry. Careful documentation of human cases will greatly enhance the development of NOTES™ in a safe manner to the benefit of patients
The Meeting Organization Subcommittee was responsible for setting the agenda for the NOTES™ summit meeting in July 2007 in Boston. If there are future meetings, which seems likely, this subcommittee will continue to function choosing the meeting sites, dates, and of course the content of the program.
NOTES™ is developing in a space that is neither purely surgical nor purely therapeutic endoscopy. As such, collaboration among the leading societies is essential to avoid turf wars, competition for scarce resources, and most importantly to optimize patient care and safety. Both SAGES and ASGE contain a large universe of areas of interest, committees, and special interest groups. NOTES™ is but a small part of the scope of these organizations. Neither SAGES nor ASGE alone could likely have galvanized the NOTES™ effort as NOSCAR™ has. Yet NOSCAR™ should not exist as a totally separate and competing society. Rather it is a bridge between the two parental organizations that has served all parties well to this point. For example, when standards or guidelines are published it is likely they will come from SAGES and ASGE jointly.
NOSCAR™ does not have a membership, per se, rather it is a community of SAGES and ASGE members that are interested in NOTES™, participate in the research grant process, and come to meetings. There are no dues to join NOSCAR™, in part, because NOSCAR™ exists under the auspices of SAGES and ASGE. Efforts are well underway in Europe and Asia to create organizations similar to NOSCAR™. It is our hope that the collaborative spirit will cross international borders in the same way it has crossed the boundaries of surgeons and gastroenterologists in North America.
David W Rattner, MD
Robert Hawes, MD ]
Author InformationSAGES. 2007; ©2007 Society of American Gastrointestinal Endoscopic Surgeons
The Registry Subcommittee of NOSCAR™ has been charged with developing a database registry to record the outcome of human NOTES™ procedures. This database was presented at the 2nd International NOTES™ Symposium in July in Boston. All teams performing NOTES™ or hybrid (NOTES™ with laparoscopic assistance) will be strongly encouraged to submit their cases to the registry. Careful documentation of human cases will greatly enhance the development of NOTES™ in a safe manner to the benefit of patients
The Meeting Organization Subcommittee was responsible for setting the agenda for the NOTES™ summit meeting in July 2007 in Boston. If there are future meetings, which seems likely, this subcommittee will continue to function choosing the meeting sites, dates, and of course the content of the program.
NOTES™ is developing in a space that is neither purely surgical nor purely therapeutic endoscopy. As such, collaboration among the leading societies is essential to avoid turf wars, competition for scarce resources, and most importantly to optimize patient care and safety. Both SAGES and ASGE contain a large universe of areas of interest, committees, and special interest groups. NOTES™ is but a small part of the scope of these organizations. Neither SAGES nor ASGE alone could likely have galvanized the NOTES™ effort as NOSCAR™ has. Yet NOSCAR™ should not exist as a totally separate and competing society. Rather it is a bridge between the two parental organizations that has served all parties well to this point. For example, when standards or guidelines are published it is likely they will come from SAGES and ASGE jointly.
NOSCAR™ does not have a membership, per se, rather it is a community of SAGES and ASGE members that are interested in NOTES™, participate in the research grant process, and come to meetings. There are no dues to join NOSCAR™, in part, because NOSCAR™ exists under the auspices of SAGES and ASGE. Efforts are well underway in Europe and Asia to create organizations similar to NOSCAR™. It is our hope that the collaborative spirit will cross international borders in the same way it has crossed the boundaries of surgeons and gastroenterologists in North America.
David W Rattner, MD
Robert Hawes, MD ]
Author InformationSAGES. 2007; ©2007 Society of American Gastrointestinal Endoscopic Surgeons
