Reverse NOTES: a Hybrid Technique of Laparoscopic and Endoscopic Retrieval of an Ingested Foreign Body

Surgeons are gaining interest in natural orifice surgery because of its minimally invasive nature. The new paradigm shift of using a natural orifice, as opposed to the abdominal wall, as a conduit for entry into the abdomen has resulted in novel solutions to solving difficult surgical problems. Repetitive foreign body ingestion continues to be one of those challenging dilemmas. Ingested objects that cannot be retrieved endoscopically must be removed by laparoscopy or laparotomy. Surgical removal, however, becomes more difficult with each subsequent operation. We report a novel technique of foreign body removal that utilizes the concept of natural orifice surgery by combining both laparoscopic and endoscopic techniques.