Towards the Holy Grail: What can we do for truly scarless surgery?

The work of Muhe and Mouret in the late 1980s, paved the way for mainstream laparoscopic procedures and it rapidly became the mainstream method for many intra-abdominal procedures. Natural orifice transluminal surgery (NOTES) and Laparo-endoscopic single-site surgery (LESS) are very exciting new modalities in the field of minimally invasive surgery which work for further reducing the scars of standard laparoscopy and towards scarless surgery. However, according to objective assessment of the literatures, there is no clearly demonstrated benefit of NOTES (LESS), even cosmesis is poorly supported and had mixed results in the available data. NOTES (LESS) is far from the truly scarless surgery. Towards the Holy Grail, we have developed several techniques of creating nonvisible scar and named them as "Scar-hidden Endoscopic Surgery". With the rapid development of science and technology, we believe that minimally invasive surgery over the next 2 decades will continue to bring remarkable change and realize truly scarless surgery even we may not be able to imagine what lies ahead.