Natural orifice translumenal endoscopic surgery (NOTES) is both foreign and familiar, invoking strong reactions from proponents and cynics alike. The deliberate violation of the wall of the gastrointestinal tract to gain access to the peritoneal, retroperitoneal, or pleural space in order to perform therapeutic or diagnostic surgical procedures is certainly a departure. An endoscopic perforation is classically seen as a serious complication, not as the basis of a surgical procedure. In view of the extraordinary success of laparoscopicand thoracoscopic surgery, NOTES has either been greeted as a logical, even less invasive approach, or as a foolish, unnecessary technique, likely to result in little of lasting value.
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