Standortbestimmung und entwicklung: NOTES - welcher zugang?

By now the first diagnostic and therapeutic NOTES interventions using the transvaginal or transgastric access have been performed successfully in humans. However, NOTES remains an experimental alternative to open conventional or laparoscopic surgery thus far. There is no universally applicable access for NOTES interventions, and the access used depends on the individual indication. Each access (transgastric, transvesical, transvaginal, and transrectal) has specific pros and cons. It must be kept in mind for clinical application that not all findings of animal models were applicable in humans. For the time being, the clinical use of NOTES should therefore be limited to controlled studies. In the long term a close cooperation between laparoscopic surgeons, gastroenterologists, gynecologists, and potentially also urologists will be necessary to effectually advance this promising approach.