Natural orifice translumenal surgery: From scales to symphonies

Purpose of review. Natural orifice transluminal endoscopic surgery is a new therapeutic procedure that combines surgical and endoscopic skills. Although not currently widely used, it is gaining momentum both in the animal laboratory and in human case reports. Recent findings. To date, 15 procedures have been successfully performed on humans worldwide. These included appendectomies (eight), liver biopsies (three), tubal ligation (one), and cholecystectomies (three). Numerous other procedures, using hybrid techniques that combine natural orifice transluminal endoscopic surgery technology with alternative conventional laparoscopic techniques, have been described in human clinical trials. In this review, we will discuss the potential benefits of this procedure over conventional surgical interventions, briefly review the major challenges to the technique (access, spatial orientation, anastomosis, and closure), and point out the technological limitations that severely handicap its potential. Summary. Despite the widespread interest in this technology, there are a lot of shortcomings: limitations in equipment, lack of clinical outcome data, and absence of randomized trials that compare it with alternative conventional surgical interventions. Nevertheless, it is crucial to remember that we have just started the evaluation process for this new exiting technology, and that, clearly, the best is yet to come.