title: Euro-NOTES Status Paper: from the concept to clinical practice.
abstract: BACKGROUND
  The concept of natural orifice transluminal endoscopic surgery (NOTES) consists of the reduction of access trauma by using a natural orifice access to the intra-abdominal cavity. This could possibly lead to less postoperative pain, quicker recovery from surgery, fewer postoperative complications, fewer wound infections, and fewer long-term problems such as hernias. The Euro-NOTES Foundation has organized yearly meetings to work on this concept to bring it safely into clinical practice. The aim of this Euro-NOTES status update is to assess the yearly scientific working group reports and provide an overview on the current clinical practice of NOTES procedures.
  
  
  METHODS
  After the Euro-NOTES meeting 2011 in Frankfurt, Germany, an analysis was started regarding the most important topics of the European working groups. All prospectively documented information was gathered from Euro-NOTES and D-NOTES working groups from 2007 to 2011. The top five topics were analyzed.
  
  
  RESULTS
  The statements of the working group activities demonstrate the growing information and changing insights. The most important selected topics were infection issue, peritoneal access, education and training, platforms and new technology, closure, suture, and anastomosis. The focus on research topics changed over time. The principle of hybrid access has overcome the technical and safety limitations of pure NOTES. Currently the following NOTES access routes are established for several indications: transvaginal access for cholecystectomy, appendectomy and colon resections; transesophageal access for myotomy; transgastric access for full-thickness small-tumor resections; and transanal/transcolonic access for rectal and colon resections.
  
  
  CONCLUSIONS
  NOTES and hybrid NOTES techniques have emerged for all natural orifices and were introduced into clinical practice with a good safety record. There are different indications for different natural orifices. Each technique has been optimized for the purpose of finding a safe and realistic solution to perform the procedure according to the specific indication.
authors.affiliation: Department of Surgery, AGAPLESION-Markus-Krankenhaus, Wilhelm-Epstein-Str. 4, Frankfurt, Germany. Karl-Hermann.Fuchs@fdk.info
authors.forename: K H
authors.initials: KH
authors.lastname: Fuchs
authors.forename: A
authors.initials: A
authors.lastname: Meining
authors.forename: D
authors.initials: D
authors.lastname: von Renteln
authors.forename: G
authors.initials: G
authors.lastname: Fernandez-Esparrach
authors.forename: W
authors.initials: W
authors.lastname: Breithaupt
authors.forename: C
authors.initials: C
authors.lastname: Zornig
authors.forename: A
authors.initials: A
authors.lastname: Lacy
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D005060:Europe; D005260:Female; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods / Q000639:trends*; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D012306:Risk; D012955:Societies, Medical; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D013536:Suture Techniques; D057170:Translational Research, Biomedical; D058106:Wound Closure Techniques
references.citation: Surg Endosc. 2012 Nov;26(11):3267-72
references.pmid: 22609984
references.citation: Surg Endosc. 2011 Jun;25(6):1791-6
references.pmid: 21184114
references.citation: Ann Surg. 2008 Aug;248(2):189-98
references.pmid: 18650627
references.citation: Dig Liver Dis. 2012 Oct;44(10):827-32
references.pmid: 22609465
references.citation: Ther Clin Risk Manag. 2012;8:329-42
references.pmid: 22888256
references.citation: Gastrointest Endosc. 2010 Aug;72(2):279-83
references.pmid: 20541750
references.citation: Gastrointest Endosc. 2008 Nov;68(5):954-9
references.pmid: 18984102
references.citation: Am J Surg. 1993 Jan;165(1):9-14
references.pmid: 8418705
references.citation: Endoscopy. 2007 Sep;39(9):761-4
references.pmid: 17703382
references.citation: Endoscopy. 2010 Jul;42(7):571-5
references.pmid: 20432208
references.citation: Gastrointest Endosc. 2007 Jul;66(1):162-7
references.pmid: 17591492
references.citation: World J Gastrointest Surg. 2010 Jun 27;2(6):187-92
references.pmid: 21160872
references.citation: Gastrointest Endosc. 2006 Feb;63(2):302-6
references.pmid: 16427939
references.citation: Best Pract Res Clin Obstet Gynaecol. 2005 Aug;19(5):757-67
references.pmid: 16087405
references.citation: Surg Endosc. 2013 Mar;27(3):746-52
references.pmid: 23052514
references.citation: Surg Endosc. 2011 Sep;25(9):3034-42
references.pmid: 21487875
references.citation: Surg Endosc. 2012 May;26(5):1352-8
references.pmid: 22052427
references.citation: Endoscopy. 2007 Oct;39(10):881-7
references.pmid: 17968804
references.citation: JSLS. 2003 Apr-Jun;7(2):171-2
references.pmid: 12856851
references.citation: Surg Endosc. 2010 Mar;24(3):601-9
references.pmid: 19688401
references.citation: Z Gastroenterol. 2012 Mar;50(3):325-30
references.pmid: 22383289
references.citation: Endoscopy. 2007 May;39(5):401-6
references.pmid: 17516345
references.citation: Br J Surg. 2009 Oct;96(10):1162-6
references.pmid: 19787764
references.citation: Surg Endosc. 2008 Jul;22(7):1717-23
references.pmid: 18461385
references.citation: J Gastrointest Surg. 2008 Oct;12(10):1717-23
references.pmid: 18704596
references.citation: Gastrointest Endosc. 2004 Jul;60(1):114-7
references.pmid: 15229442
references.citation: Surg Innov. 2013 Jun;20(3):268-72
references.pmid: 22858574
references.citation: Surg Endosc. 2011 Mar;25(3):728-36
references.pmid: 20721586
references.citation: Zhonghua Wei Chang Wai Ke Za Zhi. 2011 Sep;14(9):705-8
references.pmid: 21948538
references.citation: Surg Endosc. 2010 Aug;24(8):2022-30
references.pmid: 20174948
references.citation: Arch Surg. 2007 Sep;142(9):823-6; discussion 826-7
references.pmid: 17875836
references.citation: Surg Innov. 2007 Dec;14(4):279-83
references.pmid: 18178917
references.citation: Ann Surg. 2010 Aug;252(2):263-70
references.pmid: 20585238
references.citation: Surg Endosc. 2011 Jun;25(6):1822-6
references.pmid: 21181204
references.citation: Surg Innov. 2010 Jun;17(2):142-58
references.pmid: 20504792
references.citation: Eur J Surg. 1997 Sep;163(9):667-72
references.pmid: 9311473
references.citation: Surg Endosc. 2009 Jun;23(6):1331-6
references.pmid: 18855060
references.citation: Colorectal Dis. 2011 Nov;13 Suppl 7:43-6
references.pmid: 22098517
references.citation: Ann Surg. 2012 Feb;255(2):266-9
references.pmid: 22167005
references.citation: Surg Endosc. 2011 Apr;25(4):1004-11
references.pmid: 20976500
references.citation: Surg Endosc. 2009 Jan;23(1):24-30
references.pmid: 18814015
references.citation: Minim Invasive Surg. 2012;2012:287613
references.pmid: 22685646
references.citation: Surg Endosc. 2010 May;24(5):1205-10
references.pmid: 20186432
references.citation: Br J Surg. 2004 Sep;91(9):1111-24
references.pmid: 15449261
references.citation: Endoscopy. 2010 Apr;42(4):265-71
references.pmid: 20354937
references.citation: Gastrointest Endosc. 2007 Dec;66(6):1243-5
references.pmid: 17892873
references.citation: Gastrointest Endosc. 2005 Apr;61(4):601-6
references.pmid: 15812420
references.citation: Surg Endosc. 2006 Feb;20(2):329-33
references.pmid: 16402290
references.citation: Ann Surg. 2008 Apr;247(4):583-602
references.pmid: 18362621
references.citation: Z Gastroenterol. 2009 Nov;47(11):1160-7
references.pmid: 19885782
references.citation: Br J Surg. 2011 Nov;98(11):1635-43
references.pmid: 21713758
references.citation: J Am Coll Surg. 2011 Dec;213(6):751-6
references.pmid: 21996484
references.citation: J Am Assoc Gynecol Laparosc. 2001 Aug;8(3):438-41
references.pmid: 11509789
references.citation: Int J Colorectal Dis. 2008 May;23(5):547-50
references.pmid: 18256848
references.citation: Endoscopy. 2011 Feb;43(2):140-3
references.pmid: 21229472
references.citation: Surg Endosc. 2011 Aug;25(8):2441-8
references.pmid: 21359881
references.citation: Surg Endosc. 2010 Jul;24(7):1594-615
references.pmid: 20054575
references.citation: Surg Endosc. 2013 Feb;27(2):394-9
references.pmid: 22806531
references.citation: Chirurg. 1994 Oct;65(10):883-5
references.pmid: 7821050
references.citation: Z Gastroenterol. 2011 Apr;49(4):543-9
references.pmid: 21476185
references.citation: J Gastroenterol Hepatol. 2011 May;26(5):888-93
references.pmid: 21251061
references.citation: Surg Endosc. 2003 Jan;17(1):157
references.pmid: 12399871
references.citation: Surg Endosc. 2008 Mar;22(3):600-4
references.pmid: 17973169
references.citation: Endoscopy. 2009 May;41(5):391-4
references.pmid: 19418391
references.citation: Surg Endosc. 2009 Dec;23(12):2720-7
references.pmid: 19360364
references.citation: Obstet Gynecol. 1999 Jul;94(1):94-8
references.pmid: 10389725
references.citation: Am J Surg. 1992 Jan;163(1):63-9; discussion 69-70
references.pmid: 1733375
references.citation: Surg Endosc. 2013 Jan;27(1):339-46
references.pmid: 22806513
references.citation: Surg Endosc. 2008 Mar;22(3):605-11
references.pmid: 18027034
references.citation: Am J Gastroenterol. 2012 Mar;107(3):411-7
references.pmid: 22068665
references.citation: Gastrointest Endosc. 2005 Aug;62(2):287-92
references.pmid: 16046997
references.citation: Langenbecks Arch Surg. 2013 Jan;398(1):139-45
references.pmid: 22922839
references.citation: Surg Endosc. 2010 May;24(5):1092-8
references.pmid: 19997754