Abstract
Transsigmoidal access for NOTES operations is not limited by gender and offers an outstanding controllability of the entry point. Practically all anatomical regions of the abdomen are easily accessible. However, it is particularly prone to contamination and leakage and insufficiency of the access mean that it is far more prone to complications than using alternative access points. Currently, only few data are available on the results of animal experiments and differing technical approaches have been employed. Dedicated surgical instruments are required which should be modified according to the well proven transanal endoscopic microsurgery (TEM) set of instruments. In addition, specialized instrumentation (overtubes/trocars) and the use of transanal ultrasound seem to be recommendable.
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