Development of advanced endoscopes for natural orifice transluminal endoscopic surgery (NOTES)

Natural orifice transluminal endoscopic surgery (NOTES) is a hybrid procedure which uses flexible endoscopic technology to perform laparoscopic surgical procedures within the abdominal cavity. Initial reports of animal studies describe the use of standard endoluminal endoscopes to accomplish intra-abdominal surgeries. Current flexible scopes suffer from several deficiencies which make them unlikely to be able to be used for large scale human NOTES experiences. This review analyzes the deficiencies of current endoscopes, discuses the requirements of the ideal NOTES endoscope and reviews some of the possible "endoscopes of the future'' that are being developed for the next generation of surgery. Discussion focuses on the "R'' scope (Olympus, Tokyo, Japan) and the Transport and Cobra scopes (USGI Medical, San Capistrano, CA).