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The attempt to observe intraperitoneal organs with an endoscope using a trans- gastric approach in 2004 by Kalloo et al. heralded the commencement of a new era in endoscopy, which has led to the introduction of natural orifice transluminal endoscopic surgery (NOTES). NOTES has the potential to become an integral part of the field of medicine. So far, many techniques using NOTES have been reported through animal experiments, using diverse apparatus such as suture devices and multitasking platforms. Since a cholecystectomy was performed via a transvaginal route in a human in 2007 by Marescaux et al. from France, clinical experience is also growing. However, much has yet to be learned and many obstacles must be overcome before NOTES can be applied to clinical practice. As mentioned in the whitepaper by NOSCAR in 2005, secure sealing of the orifice after the procedure, development of appropriate instruments for the procedures, selection of suitable access to the peritoneal cavity, and adequate measures to prevent infection and complications still remain unresolved problems. Nevertheless, just as laparoscopic surgery has eventually been recognized as an important surgical technique, NOTES is expected to occupy an important place as an invaluable therapeutic modality for managing gastrointestinal disorders in the near future.
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