title: Natural orifice translumenal endoscopic surgery (NOTES).
abstract: OBJECTIVE
  Review of the application of natural orifice translumenal endoscopic surgery (NOTES) in human studies.
  
  
  BACKGROUND
  NOTES presents the latest promising technology that allows new access into the abdominal cavity through a natural orifice for multiple clinical applications. It has generated excitement among physicians for a potentially scar-free surgery. Being in its infancy stage, the safety and efficacy of this technology must be studied with scrutiny.
  
  
  METHODS
  A PubMed search was conducted in April 2008 for "natural orifice translumenal endoscopic surgery" and for "natural orifice transluminal endoscopic surgery." The search was limited to articles in English and those regarding human subjects.
  
  
  RESULTS
  The outcomes from the published case series show a level III evidence for the use of NOTES. However, human experience with NOTES is growing. Eleven articles involving human experience with NOTES have been published in 2007 and 2008. More studies are expected as the interest in this type of surgery has only just begun.
  
  
  CONCLUSIONS
  NOTES is a promising new technology that needs fine-tuning before it is safely applied in the clinical setting. This highlights the need for further animal and human studies in well-controlled settings followed by industry trials and case series. The excitement about this new approach should be directed toward more training and more studies before larger clinical applications can begin.
authors.affiliation: Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, Michigan 49008, USA.
authors.forename: SuSrap
authors.initials: S
authors.lastname: Song
authors.forename: Ed A
authors.initials: EA
authors.lastname: Itawi
authors.forename: Alan A
authors.initials: AA
authors.lastname: Saber
mesh_terms: D001062:Appendectomy / Q000379:methods; D002763:Cholecystectomy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009055:Mouth; D009392:Nephrectomy / Q000379:methods; D016896:Treatment Outcome; D014521:Urethra; D014621:Vagina