Future perspectives: natural orifice transluminal endoscopic surgery

Advances in surgical technologies and techniques including single-port (SP) robotic surgery offer the promise of less postoperative morbidity and pain, decreased length of hospitalization, and hastened convalescence. Natural orifice transluminal endoscopic surgery (NOTES) is perhaps the most promising and most complex marriage of technology and technique. As such, the SP da Vinci robot has been designed to facilitate single-incision and NOTES. Preclinical investigational work suggests feasibility, but the clinical application of NOTES has thus far been sporadic and not reproduced across multiple centers. In this chapter, we will discuss landmark studies and successful NOTES applications in humans, and consider existing challenges and future directions that may advance or hinder the widespread applicability and pragmatism of NOTES.