title: Taking NOTES: translumenal flexible endoscopy and endoscopic surgery.
abstract: OBJECTIVE
  To review the current state of natural orifice surgery and examine the concerns, challenges, and opportunities presented by translumenal research.
  
  
  RESULTS
  Translumenal endoscopic procedures have been the focus of extensive research. Researchers have reported natural orifice translumenal endoscopic surgery in a swine model in several areas involving the abdominal cavity. Diagnostic procedures have included endoscopic peritoneoscopy, liver biopsy, lymphadenectomy, and abdominal exploration. Several gynecologic procedures including tubal ligation, oophorectomy, and partial hysterectomy have been demonstrated using current commercial endoscopes. Gastrointestinal surgical procedures, including gastrojejunostomy, cholecystectomy, splenectomy, and distal pancreatectomy have been performed successfully via transgastric and/or transcolonic approaches. There have been no studies of natural orifice translumenal endoscopic surgery procedures published in humans. While fundamental questions about the emerging technology have not been scrutinized, limitations of the large animal model will pose a challenge to the development of large randomized trials.
  
  
  CONCLUSIONS
  While natural orifice translumenal endoscopic surgery may represent a paradigm shift and may offer significant benefits to patients, rigorous testing of the techniques is lacking and current data have been drawn from case series.
authors.affiliation: Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Field F
authors.initials: FF
authors.lastname: Willingham
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
mesh_terms: D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000639:trends; D004867:Equipment Design; D006801:Humans; D018583:Pliability