Instruments for transluminal laparoscopic surgery or "NOTES".

The first endoluminal operation ever developed was transanal endoscopic microsurgery (TEM), years before laparoscopic cholecystectomy was first performed. Numerous procedures using its single port system (SPS) have since been done and it is now a well-established technique in colorectal surgery around the world. There are some advantages of SPS over multiple port surgery. In 2005 we expanded on the concept of single port surgery with rigid instruments and started to develop instruments for transvaginal single port laparoscopic surgery. We now describe the instruments and system, which include devices that permit a safe access to the abdominal cavity, optimal endoscopic view and instrument steering and a precision that is not reached by current flexible technologies. The devices have been put to the test in an experimental model of transvaginal cholecystectomy. The potential benefits of the technique and the new instruments are discussed.