title: Current evidence in gastrointestinal surgery: natural orifice translumenal endoscopic surgery (NOTES).
abstract: BACKGROUND
  Natural orifice translumenal endoscopic surgery (NOTES) is a technique that uses transvisceral access to perform surgical procedures entirely through a natural orifice. Despite the increasing awareness of NOTES, there remain obstacles to its technical feasibility and widespread acceptance. Furthermore, with the paucity of high-level supporting evidence, NOTES currently remains an experimental technique.
  
  
  OBJECTIVE
  This article reviews the goals, applications, technical and practical challenges, and future direction of NOTES in gastrointestinal surgery.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106-5047, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000592:standards; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods / Q000592:standards