title: Developments in flexible endoscopic surgery: a review.
abstract: Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel - for long a "white spot" for gastrointestinal endoscopy - and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Feussner
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Valentin
authors.initials: V
authors.lastname: Becker
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kranzfelder
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Rebekka
authors.initials: R
authors.lastname: Schirren
authors.affiliation: Institute of Microtechnology and Medical Device Technology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Lüth
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Wilhelm
keywords: advanced techniques; endoscopic ultrasound; flexible endoscopic surgery; natural orifice transluminal endoscopic surgery