naturalorifice

Natural orifice refers to any body opening that occurs naturally and can be used as an access route to internal compartments for diagnostic or therapeutic purposes, without creating an external surgical incision. The term is frequently associated with NOTES, or natural orifice translumenal endoscopic surgery, a field that seeks to reach the peritoneal or other cavities through natural orifices and through a hollow organ wall using endoscopic instruments.

Access routes include the mouth (transgastric entry), the anus (transcolonic entry), and the vagina (transvaginal entry). Procedures combine endoscopy with surgical techniques to perform tasks such as organ visualization, biopsy, or resections, while avoiding large abdominal incisions. Entry sites are typically closed with endoscopic or surgical methods, and infection risk is a major concern.

History and development: The concept emerged in the late 20th and early 21st centuries; early animal studies informed human attempts in the mid-2000s. Limitations persisted, and by the 2010s much of NOTES remained experimental, with many centers using hybrid approaches that combined NOTES access with laparoscopic aid rather than complete incisionless surgery.

Applications and limitations: Potential benefits include avoiding external incisions, reduced wound complications, and faster recovery. Drawbacks include a steep learning curve, longer procedures, risk of intra-abdominal infection, leakage from the access site, and challenges with reliably closing the entry. Evidence on long-term safety and outcomes remains limited.

Current status: NOTES remains largely investigational and is not a routine standard of care. Some procedures are performed in specialized centers, often within clinical trials. Ongoing research focuses on safer closure techniques, infection control, patient selection, and training.