Abstract
The new surgical concept of "natural orifice transluminal endoscopic surgery" (NOTES) breaks with the old dogma that gastrointestinal flexible endoscopy should be performed exclusively within the gastrointestinal lumen. It guides flexible endoscopy into the peritoneal cavity and to date any access to this was and is a feared complication. NOTES offers a new potential alternative to open surgery as well as laparoscopic surgery. Technical challenges of this new technique include the need for the development of new tools and devices. This is most important for the access to and closure of incisions to the peritoneal and thoracic cavities. The successful incision and closure is a prerequisite for the development of acceptable indications for this new method. In this overview the access and closure techniques currently used as well as some of those which are being considered will be described. Furthermore, possible indications for NOTES will be evaluated and discussed.
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