NOTES: evolving trends in endoscopic surgery

Intraluminal endoscopic surgery is a recent innovation to minimally invasive surgery. This technique provides access to the peritoneal cavity through a natural orifice. The technique holds the promise for "incisionless," less invasive procedures without the risk of postoperative sequelae as in the standard surgical approach, particularly in high risk patients. The hope of combining the skill and experience of endoscopists and surgeons into a defined specialty has attracted worldwide attention. It is anticipated that the skill sets required will be a hybrid that includes laparoscopic skills as well as endoscopic expertise. The studies in animal models of natural orifice translumenal endoscopic surgery (NOTES) have demonstrated the safety and feasibility of various types of intraabdominal surgeries, including transgastric liver biopsy, cholecystectomy, tubal ligation and peritoneoscopy amongst others. This review discusses the evolution of NOTES, the types of procedures performed and the challenges that lie ahead in the further development of this technique.