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Minimally Invasive Surgery
Volume 2012, Article ID 896952, 7 pages
Review Article

Natural Orifice Transesophageal Endoscopic Surgery: State of the Art

1Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4709-057 Braga, Portugal
2ICVS/3B's, PT Government Associate Laboratory, 4709-057 Braga/Guimarães, Portugal
3Department of Pediatric Surgery, Centro Hospitalar do Porto, 4099-001 Porto, Portugal
4Department of Gastroenterology, Hospital de Braga, 4710-243 Braga, Portugal
5Department of Pediatric Surgery, Hospital de Braga, 4710-243 Braga, Portugal

Received 9 December 2011; Accepted 9 February 2012

Academic Editor: Luigi Boni

Copyright © 2012 João Moreira-Pinto 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.


The main goal of Natural Orifice Transluminal Endoscopic Surgery (NOTES) is performing surgery avoiding skin incisions. Theoretical advantages of NOTES include decreased postoperative pain, reduction/elimination of general anesthesia, improved cosmetic outcomes, elimination of skin incision-related complications such as wound infections and hernias, and increased overall patient satisfaction. Although various forms of port creation to accomplish thoracic NOTES procedures have been proposed, transesophageal NOTES has been shown to be the most reliable one. The evolution of endoscopic submucosal transesophageal access resulted in the development of per-oral endoscopic myotomy (POEM), which had a fast transition to clinical practice. The authors present a review of the current state of the art concerning transesophageal NOTES, looking at its potential for diagnostic and therapeutic interventions as well as the hurdles yet to be overcome.