Natural orifice surgery in thoracic surgery

Since Kallo et al. reported the first transgastric peritoneoscopy in 2004, several studies have shown the safety and benefits of natural orifice surgery (NOS) in abdominal surgery in human studies. The feasibility of NOS thoracoscopy has been reported using different natural orifice access (transvesical, transesophageal, transtracheal, transoral, and transumbilical) in porcine and canine models. However, only a minority of thoracic procedures (myotomy for achalasia, sympathectomy for palmar hyperhidrosis) are performed using the NOS technique (1-9). This paper presents the development and current status of our work, and provides an overview of the questions that still need further investigation, regarding NOS in thoracic disease and future plans.