NOTES-Natural orifice transluminal endoscopic surgery: Why not?

Abstract

Since natural orifice transluminal endoscopic surgery (NOTES) was first described by Anthony Kalloo, it has attracted tremendous interest from surgeons and gastroe nterologist all around the world. This special issue of the World Journal of Gastrointestinal Surgery explores the current possibilities and future potential of the most disruptive revolution in the field of surgery represented by the NOTES approach. In the future, new technologies developed for this approach and deeper insight into several gastrointestinal diseases will lead to the design of completely new interventional procedures and change the way we will operate, bringing us to the previously unimaginable goal of "no scar surgery". EDITORIALWe, human beings, don't like to undergo surgical proced ures, not only for the fear and effect of the disease, but also for the expected postoperative pain, the risks and side effects of anesthesia, the recovery time needed after an operation and the permanent visible scars that will forever leave an unpleasant reminder of the experience and alter the esthetic of the person [1] . The revolutionary concept of natural orifice translumi nal endoscopic surgery (NOTES) described by Kalloo et al [2] , promises to overcome many of the historical drawbacks of the surgical approach.After a long period of testing in experimental settings the NOTES approach has now proven its feasibility and safety in preliminary clinical experience in the performance of basic surgical procedures [35] . At same time, new fields of surgery and innovative approaches are being explored in order to allow more advanced procedures to be perf ormed [6,7] . So far, the major efforts in the field have been primar ily concentrated on the use of natural orifice approaches to simply replicate traditional radical procedures whilst respecting established operative strategies. However, the NOTES approach is also stimulating the appreciation of complementary advanced technologies and new surgical concepts, that will allow us not only to perform the pro cedures via a minimal access, but also to minimize the extent or even the need for a surgical resection. These new concepts are represented for example by genetically driven gastrointestinal cancer treatment and manipulation of the gastrointestinal tract for the cure of metabolic disorders [810] . In fact, Better genetic and physiopathological knowl edge will help us to customize the surgical approach to the specific needs of the patient. This will avoid the usual "one size fits all" strategy that often relies on extended surgical resection of large specimens simply to perform the corr ect cancer staging. This approach rarely adds any clinical benefit to the patients while may impair their functional outcome and quality of life [11] .