Natural Orifice Translumenal Endoscopic Surgery (NOTES) Towards Brighter Future

Abstract

In natural orifice translumenal endoscopic surgery (NOTES) intentional puncture of one of the viscera (e.g., stomach, rectum, vagina, and urinary bladder) is made and an endoscope is used to access the abdominal cavity and perform an intra-abdominal operation. Early studies focused on feasibility, including such accomplishments as pure transgastric splenectomy and gastrojejunostomy. Contemporary studies are investigating the infectious and immunologic implications of NOTES and honing the tools and techniques required for complex abdominal operations. Today NOTES has entered the clinical arena in quite a few cases: The first clinical series of transgastric peritoneoscopy has recently been published; many groups are accumulating patients in studies of NOTES cholecystectomy, either via the transgastric or transvaginal route; and a series of transgastric appendectomies has been well publicized, yet they remains unpublished. Although clinically NOTES is gaining momentum, the field should remain in check while rigorous studies are performed and clinical trials are undertaken. The zeal for NOTES should not take precedence over the welfare of the patient.