True natural orifice transluminal endoscopic surgery-transgastric cholecystectomy and beyond

Natural orifice transluminal endoscopic surgery (NOTES) represents a revolutionary advancement in minimally invasive surgery, eliminating the need for external incisions and offering faster recovery and improved aesthetics. Endoscopic transgastric cholecystectomy (ETGC), a NOTES-based procedure, stands out for its potential to revolutionize gallbladder removal by offering a truly scarless alternative to traditional laparoscopic cholecystectomy (LC). This review explores the historical development of cholecystectomy, evolution of NOTES, and emergence of ETGC as a feasible alternative to LC. We highlight the technical refinements that have enabled ETGC, including innovations in full-thickness resection and suturing techniques, and discuss challenges such as visibility, orientation, and wound closure. Finally, we examine the role of robotic platforms in enhancing precision and expanding clinical applications by positioning ETGC as a transformative technique in the era of minimally invasive surgery.