The ANUBIS™ project.

The aims of the ANUBIS™ project developed in IRCAD-Strasbourg were to evaluate the concept and the potentialities of natural orifices transluminal endoscopic surgery (NOTES), to develop a specific instrumentation, to translate the research work into clinical settings and to provide education and training. To achieve these goals, an intensive collaboration was established between IRCAD, which comprises medical staff (surgeons, gastroenterologists, gynaecologists), computer scientists and robotics engineers, and industrial partners. Between 2005 and 2008, more than 400 experimental procedures were performed on inanimate models, ex-vivo tissues, animal models and human cadavers. Cholecystectomy was defined as the procedure that would realize the translation of experimental work into the clinical setting. The first human transvaginal cholecystectomy was performed at the end of the second year of the project. Transgastric cholecystectomy followed six months later. A new concept of therapeutic flexible endoscope (Anubiscope™, Storz Endoskope,Tutlingen, Germany) was developed, and different modalities of closure of the viscerotomies were elaborated. Implementation of the experimental program into the clinical setting and translation of technological research into a finalized industrial product were achieved thanks to a rigorous, extensive and stepwise study of the potentialities of NOTES. Education and training were organized and 500 participants attended the specific courses and hands-on sessions organized at IRCAD-EITS.