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Natural Orifice Transluminal Endoscopic Surgery (NOTES) involves the technique of performing abdominal surgery through an incision in the digestive tract such as the stomach or colon. Endoscopes are passed through the luminal incision and both diagnostic and therapeutic interventions have been reported in animal models including transgastric organ resection. Most recently, a transcolonic approach using a direct approach from the lower abdomen has been advocated as being particularly well suited to access upper abomdinal structures that are often more difficult to work with using a transgastric approach. Originally described in animals by researchers at Johns Hopkins University (Dr. Anthony Kalloo et al.), this technique was recently used in humans (by Drs. G.V. Rao and N. Reddy). Senior leadership from the American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal Endoscopic Suregons (SAGES) organized a working group of surgeons and gastroenterologists in 2006 to develop standards for the practice of this emerging technique. This group is known as NOSCAR or Natural Orifice Surgery Consortion for Assessment and Research. A White Paper on NOTES was released by NOSCAR simultaneously in two medical journals in May 2006. Proponents and researchers in this field recognize the potential of this technique to revolutionize the field of minimally invasive surgery since abdominal incisions are avoided. Potential advantages include the need for reduced anesthesia requirements, faster recovery and hospitalization stays, avoiding potential complications of transabdominal wound infections (i.e. "hernias"), less immunosuppresion, better post operative pulmonary and diaphragmantic function, and the potential for "scarless" abdominal surgery. Critics challenge the safety and advantage of this technique in the face of effective minimally invasive surgical options such as laparascopic surgery.
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