Natural orifice transluminal endoscopic surgery (NOTES)

Introduction In the past few years, gastrointestinal endoscopy has been enriched by a novel concept, natural orifice transluminal endoscopic surgery (NOTES). In this innovative endoscopic technique abdominal organs are approached through natural orifices (mouth, anus, vagina) in order to perform intra-abdominal diagnostic and therapeutic procedures. Unlike standard surgical procedures, NOTES avoids the need for abdominal incision, and also offers specific advantages in selected patient populations. Since the first presentation on NOTES at Digestive Disease Week (DDW) in 2000, research interest in NOTES has grown steadily ([ Fig. 1 ]). This year, numerous abstracts focused on the potential problems that arise with NOTES in clinical practice, such as problems with access and closure, technical limitations of instruments (and innovative solutions to these), and complications and their management, while others focused on the potential advantages and the feasibility of novel NOTES interventions.