Transvaginal laparoscopic cholecystectomy: endoscopically assited

The advent of NOTES on the scene has attracted attention and enthusiasm, but also caution and recommendations for animal studies that better define the surgical technique, test new dedicated instruments, overcome potential problems, and explore applicability to clinical settings [2]. Following this recommendation, a large number of animal studies have been performed during the last 3 years [3]. The experimental techniques described by Bessler et al. and by us are good examples of this strategy for the safe development of NOTES technology. However, the two techniques are two sides of the same coin: one is endoscopically based with laparoscopic assistance; the other is laparoscopically based, with endoscopic assistance. Both of the procedures are performed with conventional endoscopic and laparoscopic devices, which are not specifically designed for this type of surgery, making necessary a hybrid approach to ensure safe and reliable operation.When a multitasking flexible platform becomes available, these technical differences will be overcome and pure NOTES procedures will be accessible to the majority of endoscopic/laparoscopic surgeons. At that point, the two sides of the coin will be the same