Natural orifice translumenal endoscopic surgery (NOTES): safe implementation through technological innovation

BACKGROUND: NOTES is advancing at a rapid pace with large registries of human applications and increasing evidence to support safety and efficacy. We have however arrived at a stage in the development of the technique where many conceptual applications are not supported by available technology to ensure safe implementation. METHODS: The data presented in this editorial are based on the views of the authors and reviews of the literature which have been conducted using PubMed, a search tool of the National Library of Medicine and the national institute of Health, including the MEDLINE database and the Cochrane library until the 1st of February 2011. RESULTS: This editorial reviews the technological challenges that must be overcome and novel solutions are discussed. CONCLUSIONS: For NOTES to realise its full potential, surgeons have to wait for technology to catch up with ideological innovation before embarking on more complex procedures than the hybrid transvaginal feasibility studies currently taking place.