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Minimally Invasive Surgery
Volume 2012 (2012), Article ID 189296, 8 pages
Review Article

Natural Orifice Translumenal Endoscopic Surgery in Humans: A Review

1Division of Digestive Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
2Department of Surgery, School of Medicine, Emory University, Atlanta, GA 30322, USA

Received 9 January 2012; Accepted 6 March 2012

Academic Editor: Silvana Perretta

Copyright © 2012 Michelle P. Clark et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Natural orifice translumenal endoscopic surgery (NOTES) had its origins in numerous small animal studies primarily examining safety and feasibility. In human trials, safety and feasibility remain at the forefront; however, additional logistic, practical, and regulatory requirements must be addressed. The purpose of this paper is to evaluate and summarize published studies to date of NOTES in humans. The literature review was performed using PUBMED and MEDLINE databases. Articles published in human populations between 2007 and 2011 were evaluated. A review of this time period resulted in 48 studies describing procedures in 916 patients. Transcolonic and transvesicular procedures were excluded. The most common procedure was cholecystectomy (682, 75%). The most common approach was transvaginal (721, 79%). 424 procedures (46%) were pure NOTES and 491 (54%) were hybrid NOTES cases. 127 (14%) were performed in the United States of America and 789 (86%) were performed internationally. Since 2007, there has been major development in NOTES in human populations. A preponderance of published NOTES procedures were performed internationally. With further development, NOTES may make less invasive surgery available to a larger human population.