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J Hepatobiliary Pancreat Surg. 2009;16(3):261-5. doi: 10.1007/s00534-009-0087-5. Epub 2009 Apr 22.

Natural orifice surgery (NOTES) and biliary disease, is there a role?

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Legacy Health System, Providence Health and Services, 1040 NW 22 ave suite 560, Portland, OR 97210, USA.



Natural orifice translumenal endoscopic surgery (NOTES) is a term coined by a joint group of surgeons and gastroenterologists organized by Society for American Gastrointestinal Endoscopic Surgeons (SAGES) and American Society of Gastroenterologists (ASGE) to describe the fusion of minimally invasive surgery and interventional endoscopy.


Current literature and compiled personal experience in NOTES was reviewed to provide an expert opinion on the role of NOTES in HPB surgery.


The majority of experience obtained to date has been in animal models. The few human cases and clinical trials that have been performed show excellent promising outcomes with minimal morbidity.


The merger of interventional endoscopy and minimally invasive surgery is a natural progression as we continually push the envelope of minimally invasive surgery. Endoscopic retrograde cholangiopancreatography, biliary stents and endoscopic ultrasonography have forever changed treatment algorithms in HPB surgery. Advancement of minimally invasive surgery to include the liver resections, pancreatic resections and pseudocyst management has improved morbidity and become the standard of care in many cases. Continued development of natural orifice techniques may further alter the approaches to the biliary tract, liver and pancreas.

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