Endoscopic Surgery

t is amazing to think that only a decade ago, an intestinal perforation resulting from an endoscopic intervention was considered a major violation of medical care. However, the concept of breaching the gastrointestinal tract to gain access to the peritoneal and even the thoracic cavity is rapidly gaining acceptance. This review discusses the current status of natural orifice translumenal endoscopic surgery (NOTES). Rationale for NOTES Throughout the history of medicine, physicians have sought less invasive approaches to the diag-nosis and therapy of diseases. Perhaps its relative lack of invasiveness is the greatest attraction of NOTES to the medical and general public, particularly with regard to cosmetic effects. A frequently touted advantage of laparoscopic surgery over open surgery is a better cosmetic outcome. With NOTES, perfect cosmetic results are possible even when peritoneal intervention is required.1 Since the advent of interventional endoscop-ic therapy, the fields of gastrointestinal surgery and interventional endoscopy have been on converging paths.2 Therapeutic endoscopists are becoming increasingly invasive, perform-ing interventions such as transgastric pseudo-cyst drainage and pancreatic necrosectomy and treating endoscope-related perforations that would have had to be managed surgicall