Quo vadis NOTES?Quo vadis NOTES?

BACKGROUND: The term NOTES® (Natural Orifice Transluminal Endoscopic Surgery) summarizes new operation techniques, which are a synthesis of endoscopy and laparoscopy, and do not leave scars on patients' skin. METHODS: The article reviews the literature on the one hand and reflects our personal experience with experimental and clinical NOTES® cases on the other hand, discussing devices, approaches, tissue approximation techniques, prevention of infection, and risks. RESULTS: NOTES® has become a clinical reality. More than 300 human cases have been performed worldwide under IRB (Institutional Research Board) approval by July 2008. The results have been the same as if laparoscopy had been performed, with better cosmetic results. Some studies show a tendency towards lesser use of postoperative pain medication. It has to be proved if faster recovery is also an advantage of NOTES®. CONCLUSIONS: There is a future for flexible laparoscopy and thoracoscopy. NOTES® instruments provide better cosmetic results, leave the abdominal wall intact, and may have advantages for atraumatic surgery in the mediastinum. Patients and physicians can decide individually if the new available devices will be used in a transluminal or single port approach after intensive consideration of advantages and drawbacks of each access approach.