[The natural orifice surgery concept. Vision and rationale for a paradigm shift]

During the 20th Century, laparoscopic surgery achieved high standards and significantly reduced morbidity. In order to make surgery simpler and safer, a new concept, natural orifice surgery (NOS), has recently been introduced. The approach to the abdominal cavity may be transoral-transgastric, transvaginal-transdouglas or transanal-transrectal. This article describes the logic behind this approach and the expected challenges.

In order to realize this goal, we founded the first European based working group on NOS. This group concentrates on the development of transdouglas procedures in women by using the transdouglas endoscopic device (TED). This is a wide, multi-channel instrument, which will enable surgery to be performed via a single entry.

Simulation of various intra-abdominal operations, such as staging, cholecystectomy, appendectomy, myomectomy und ovarectomy, using TED has already been carried out. Practical studies are planned in the near future.

The feasibility of NOS has been demonstrated in various experimental studies. We believe that this technique will create a spectrum of innovative and high quality operations and will improve patient safety.