title: Success and complication parameters for laparoscopic surgery: a benchmark for natural orifice transluminal endoscopic surgery.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) currently represents an issue of particular interest among surgeons and gastroenterologists. The principle of NOTES is the reduction of the operative trauma by using natural orifices of the human body to access the abdominal cavity. Regarding the tendency to further minimization of the surgical trauma, NOTES may be considered as a logical step in the evolution of minimally invasive surgery. Pioneers of this technique regard NOTES as the successor to laparoscopic surgery in enabling surgeons and gastroenterologists to conduct scarless surgery. This might not only lead to better cosmetic results but also enhance the prospect of decreases in wound infections and incisional hernias, as well as reducing operative stress, postoperative immobility, and pain.
  
  
  METHODS
  In this article the authors collect and review the existing literature concerning NOTES and establish a benchmark for the assessment of this new technique by stating results from conventional minimally invasive surgery as the gold standard.
  
  
  CONCLUSIONS
  It is shown that publications investigating possible advantages or long-term results of NOTES are scarce. However, the investigation and verification of potential advantages and disadvantages represent the most important step in the development of a new technique. Only proven advantages would justify the broad implementation of a new technique in relation to its specific risks. Conventional laparoscopic surgery as the current standard of minimally invasive surgery will be the benchmark for NOTES with regard to most issues. Superiority of NOTES in at least several issues would be the best argument for its further implementation into clinical practice.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. carsten_gutt@med.uni-heidelberg.de
authors.forename: C N
authors.initials: CN
authors.lastname: Gutt
authors.forename: B P
authors.initials: BP
authors.lastname: Müller-Stich
authors.forename: M A
authors.initials: MA
authors.lastname: Reiter
mesh_terms: D000818:Animals; D019985:Benchmarking; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000592:standards*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000592:standards; D023421:Models, Animal; D013552:Swine