Natural orifice translumenal endoscopic surgery 2009: what is the future for the gastroenterologist?

In order to predict whether the gastroenterologist will have a role in the rapidly developing field of natural orifice translumenal endoscopic surgery (NOTES), it is helpful to examine the new developments in this field. Our goal in this review is to examine the recent developments in the field and study the gastroenterologists' role to best make this prediction.

Perhaps the most significant development in the field of NOTES has been the favorable patient and physician preferences for NOTES. There is evidence that patients would prefer NOTES cholecystectomy to laparoscopic cholecystectomy. The most common reason for this choice appears to be the lack of pain and visible scar. Another very significant development has been the reality of human NOTES procedures. Multiple centers have reported human NOTES procedures, including transgastric appendectomies, transgastric liver biopsies, transgastric tubal ligation and transvaginal cholecystectomy without major complications. Gastroenterologists' expertise with flexible endoscope was critical in the above cases. Recently, a few publications have also shown how gastroenterologists with expertise in endosonography can have a role in affirming safe access.

Although no one can predict with certainty where the field of NOTES will be in 1 year, it seems likely that gastroenterologist involvement will be necessary and advancements in this field will be applicable and diffuse into our daily practice.