History of Natural orifice transluminal endoscopic surgery

This technique has been used for diagnostic and therapeutic procedures in animal models, including transgastric (through the stomach) organ removal. Most recently, the transvesical and the transcolonic approaches have been advocated by some researchers as being more suited to access upper abdominal structures that are often more difficult to work with using a transgastric approach. In this sequence, a group from Portugal used transgastric and transvesical combined approach to increase the feasibility of moderate complex procedures such as cholecystectomy. NOTES was originally described in animals by researchers at Johns Hopkins University (Dr. Anthony Kalloo et al.), and was recently used for transgastric appendectomy in humans in India (by Drs. G.V. Rao and N. Reddy).On June 25 2007 Swanstrom and colleagues have reported the first human transgastric cholecystectomy.

The transvaginal access to NOTES seems to be the most safe and feasible for clinical application. In early March 2007, the NOTES Research Group in Rio de Janeiro, Brazil, lead by Dr. Ricardo Zorron, performed the first series of transvaginal NOTES cholecystectomy in four patients, based in previous experimental studies. Later on the same month, Dr. Marc Bessler was successful in performing a hybrid transvaginal cholecystectomy with 3 abdominal ports New York City. Dr. Marescaux, from EITS-IRCAD Strassbourg, France, has performed (arguably) the first pure NOTES cholecystectomy in a patient in early April 2007 using only a Veress needle as the only abdominal port. With fewer potential complications, the procedure has a disadvantage of being possible only in women.

Proponents and researchers in this field recognize the potential of this technique to revolutionize the field of minimally invasive surgery by eliminating abdominal incisions. NOTES could be the next major paradigm shift in surgery, just as laparoscopy was the major paradigm shift during the 1980s and 1990s. Potential advantages include the need for reduced anesthesia requirements, faster recovery and hospitalization stays, avoiding potential complications of transabdominal wound infections (i.e. "hernias"), less immunosuppresion, better post operative pulmonary and diaphragmantic function, and the potential for "scarless" abdominal surgery. Critics challenge the safety and advantage of this technique in the face of effective minimally invasive surgical options such as laparoscopic surgery.