The Second SAGES/ASGE White Paper on natural orifice transluminal endoscopic surgery: 5 years of progress

Background When the concept of Natural Orifice Transluminal Endoscopic Surgery (NOTES (TM)) was first introduced, many physicians could envisage its potential as a less invasive and more cosmetic way to perform surgery. The potential for harm if NOTES was adopted too rapidly was also readily apparent. To ensure the responsible development of these technologies and techniques and to encourage accurate and honest outcome assessment in humans, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the American Society for Gastrointestinal Endoscopy (ASGE) assembled a Joint Committee to serve as a working group to review the issues involving NOTES. This working group subsequently published the ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery White Paper [1, 2], which laid out the fundamental challenges to be addressed and outlined a pathway for the responsible development and evaluation of NOTES. As part of this mission, the Joint Committee also created an organization called Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR). NOSCAR organized international meetings, developed and sought funding for a research agenda, fostered the translation of research findings into clinical trials, and began development of a human registry to track the clinical adoption of NOTES.