title: Natural orifice translumenal endoscopic surgery.
abstract: OBJECTIVE
  Since its introduction in 2000, natural orifice translumenal endoscopic surgery (NOTES) has gained a great deal of attention from gastroenterologists and surgeons all over the world. In this article, we will review the progress in the field of NOTES and present the latest publications that provide some answers and solutions to the barriers suggested by the Natural Orifice Surgery Consortium for Assessment and Research white paper.
  
  
  RESULTS
  Because of the first human NOTES procedure by Rao and Reddy, more pioneering procedures, including transgastric and transvaginal cholecystectomies, appendectomies, and hernia repairs, have been performed. Although NOTES researchers continue to experiment with new innovative equipment and procedures in the lab, more structured work, including randomized controlled trials, has been published.
  
  
  CONCLUSIONS
  In the last several years, there has been growing interest in NOTES, which has translated into exciting animal research work and publication of randomized controlled trials. Additionally, preliminary NOTES human procedures have been successfully performed. When suitable instruments become available, the subsequent step should be comparing NOTES with current laparoscopic approaches. Superiority or even equality of NOTES to laparoscopic surgery would be the best argument for advancing and integrating implementation into clinical practice.
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland 21287, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
mesh_terms: D004066:Digestive System Diseases / Q000601:surgery*; D020776:Endoscopes, Gastrointestinal / Q000592:standards*; D016145:Endoscopy, Digestive System / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D015203:Reproducibility of Results