Current status of natural orifice translumenal endoscopic surgery (NOTES).

he concept of natural orifice translumenal endoscopic surgery (NOTES) epresents the evolution of surgery to the goal of less invasive procedures, nd new endoscopic approaches may be possible and safe even when ntering via transgastric, colonic, urethral, or vaginal access. The idea of linical NOTES started by the evolution of more invasive endoscopic rocedures in recent years. A precursor of the natural orifice surgery concept as undoubtedly the performance of more advanced procedures by skilled rocedural endoscopists and surgeons, with evolution of endoscopic retrorade cholangiopancreatography, percutaneous endoscopic gastrostomy PEG), pancreatic pseudocyst drainage, transanal endoscopic microsurgery TEM), endoscopic mucosal resections for gastric cancer, and, nowadays, nterventional endoscopy. Besides, transorificial extractions of larger speciens were reported during laparoscopy since 1993. Seifert and colleagues n 2000 reported transgastric endoscopic debridement of necrotic pancreas in patients using a Dormia basket and also removed a necrotic spleen in 1 of hese patients. The growing enthusiasm in the medical community led to the formation of he Natural Orifice Surgery Consortium for Assessment and Research NOSCAR) working group in 2006. This team included a core group of astroenterologists and surgeons representing the American Society for astrointestinal Endoscopy and the Society of American Gastrointestinal ndoscopic Surgeons. Their primary responsibility was to oversee the evelopment of this field into mainstream clinical practice in humans in a cientific manner with limited preventable errors. The major tenet of this ociety was the strict use of institutional review board (IRB) approval for any uman investigation into NOTES. The proceedings were published as a hite paper and an international conference on NOTES has been held yearly ince 2006. The NOSCAR Registry of human NOTES started in the United tates in 2008 with the support of both the Society of American Gastroin-

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