Natural orifice transluminal endoscopic surgery

It is now more than a decade since the first description of the concept of natural orifice transluminal endoscopic surgery (NOTES). The first decade was characterized by a substantial number of experimental studies conducted to develop optimal techniques and overcome various challenges. Reports of clinical NOTES procedures in humans began to appear in 2007 and increased in subsequent years. The gastroenterologist performing early experimental studies in animals has now been largely replaced by a surgeon, operating mainly in a hybrid fashion (with laparoscopic assistance) and often using rigid instruments, sparing the flexible endoscope.