The dirty way to the gallbladder

Laparoscopic surgery has dramatically reduced the need for long incisions in surgery. During laparoscopic surgery, trocars for a rigid optic and for each instrument are introduced through the abdominal wall. Today, in natural orifice endoluminal surgery (NOTES), the natural orifices are used to introduce a flexible endoscope with or without the use of an overtube. Inside the human body, entrance to the peritoneum is gained by making an incision in the organ wall. Most procedures do still use one or more trocars through the abdominal wall, with a preference for location at the umbilicus.

Proponents of NOTES believe that it is a new and significant step in reducing the invasiveness of the procedure. We do agree that visible incisions are reduced or possibly in the future will be avoided altogether, by using a flexible optic with instruments either guided through integrated channels, or by channels integrated into an overtube.

This means better cosmesis. What is unclear but crucial is whether NOTES can be as safe as laparoscopic surgery.