Identifying and overcoming the potential barriers to the adoption of natural orifice transluminal endoscopic surgery

Natural orifice translumenal endoscopic surgery (NOTES) is an emerging innovative approach to performing minimally invasive surgical procedures. In its full potential, the concept of incisionless surgery will have mass appeal to patients. However, the barriers to adopting NOTES will have to be overcome before widespread acceptance of these techniques can occur. These potential barriers include infection, visceral leakage, difficulties in tissue manipulation, and increased cost. The history of surgical innovation has continuously overcome similar problems in other settings, and all of these potential obstacles are likely solvable. Training surgeons will be an additional barrier that will need to be overcome, but this obstacle will need to be approached differently than when laparoscopy was introduced, as standards are higher today for privileging and credentialing in most hospitals than 20 years ago. Alternative technologies that were not adopted prior to the introduction of NOTES may now appear more viable making the competitive environment more complex. Increased funding for comparative effectiveness studies and training for competency in innovation will also need original solutions, but are clearly in our patients' best interest.