Since the advent and wide spread adoption of laparoscopic cholecystectomy in the late 1980s, the field of gastrointestinal (GI) surgery has continually evolved towards less invasive techniques. Endoscopy has been increasingly adopted to assist in laparoscopic and open abdominal surgery. Applications are as wide-ranging as evaluation of the myotomy during laparoscopic Heller, combined endoscopic and surgical techniques for placement of percutaneous endoscopic gastrostomy (PEG) tubes, and intra-operative lesion identification during gastric or colon resection. This utilization of endoscopy by GI surgeons has coincided with the development of more advanced intraluminal procedures by gastroenterologists. These endoscopic interventions incorporate surgical techniques such as retraction, dissection of tissue planes, hemostasis, and respect for oncologic principles. The evolution of natural orifice transluminal endoscopic surgery (NOTES) is a logical culmination of this hybridization.
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