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Page 10 of 11 Jeong et al. Mini-invasive Surg 2019;3:38 I http://dx.doi.org/10.20517/2574-1225.2019.42

in February 2017 and this pure NOTES transanal total colectomy has been the first case and is a unique
case thus far.

NOTES for intraperitoneal organs
NOTES methods for accessing the abdominal cavity may include transanal and transvaginal routes, and,
especially in patients with stoma, the stoma may be recognized as one of the natural openings. For the
transanal approach, matching between the specimen size including the mass and the accommodation of
the sphincter is important, and, for the transvaginal approach, virginity or parity can be an important
consideration. The transvaginal approach is advantageous for the extraction of quite large specimens,
especially specimens made with en-bloc resection. It also has an advantageous approach in terms of angle
with the abdominal cavity. Postoperative sutures may also be easier than intestinal anastomosis performed
by transanal access surgery, and relatively less burden on leakage. In patients with stoma, the stoma can
be recognized as one of the natural openings in a broad sense. The abdominal cavity can be accessed by
taking down the stoma or partial splitting the margin of the stoma without inflicting any other wound.
This is done by performing a single laparoscopy and finishing again with stoma to maintain the same
condition as before.

In other surgical areas, various NOTES-type surgeries are newly introduced and performed. Surgery
for various organs and intestines in the abdominal cavity is ultimately developing as absolutely scarless
surgery. Some of them are already making significant progress, and, in cancer surgery, homework remains
a matter of approach and adherence to oncological laws as in any surgery.

DECLARATIONS
Authors’ contributions
Performed surgeries and contributed to conception and design of the study: Lee SC
Performed data acquisition and analysis, as well as provided technical support: Choi BJ
Wrote the thesis: Jeong WJ

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

REFERENCES
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2. Lirici MM, Hüscher CG. Techniques and technology evolution of rectal cancer surgery: a history of more than a hundred years. Minim