title: NOTES--third generation surgery. Vain hopes or the reality of tomorrow?
abstract: BACKGROUND
  Laparoscopic approach has made many procedures less invasive; however, it seems like this is not enough. The newest challenge for the medical environment is applying the scarless surgery in humans. In this article, we review the origin, current state of art, and future of natural orifice transluminal endoscopic surgery (NOTES). The registered base of research in humans is yet scarce; however, the porcine model experimental studies hold a great promise. In NOTES, peritoneal cavity can be easily achieved, and some procedures are feasible through the natural orifices like digestive tract, vagina, or urinary bladder. If safety and advantages of these approaches will be proven beyond question, NOTES procedures are likely to be adapted in humans after overcoming the critical obstacles, like reliable closure methods, indispensable equipment invention, the multidisciplinary specialists training, etc. The aim of this article was to review available literature to provide current state of art in NOTES surgery.
  
  
  METHODS
  Medical databases were searched for animal and human experience with NOTES to give an overview of history, current state of art, and future of this technique.
  
  
  RESULTS
  NOTES is currently the subject of the intensive research. It seems like this is only the matter of time when a transluminal access to the abdominal or even thoracic cavity will become the reality. Moreover, this will enable the management of some diseases in a possibly minimally invasive pattern, nearly painless and leaving no scar at all.
authors.affiliation: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland. kobiela@amg.gda.pl
authors.forename: Jarek
authors.initials: J
authors.lastname: Kobiela
authors.forename: Tomasz
authors.initials: T
authors.lastname: Stefaniak
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Mackowiak
authors.forename: Andrzej J
authors.initials: AJ
authors.lastname: Lachinski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Sledzinski
mesh_terms: D000818:Animals; D002921:Cicatrix / Q000517:prevention & control*; D003479:Curriculum / Q000639:trends; D004066:Digestive System Diseases / Q000601:surgery; D004724:Endoscopy / Q000193:education / Q000639:trends*; D005544:Forecasting; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D013038:Specialization / Q000639:trends