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    Natural Orifice Surgery: No Scars

    Surgery Without External Cuts Called 'Next Greatest Surgical Evolution'

    NOTES vs. Laparoscopy

    The NOSCAR group obviously is promoting the "no scar" aspect of NOTES. But current minimally invasive laparoscopic surgical techniques already leave no lasting scar, says John G. Hunter, MD, professor and chairman of surgery at Oregon Health & Science University in Portland.

    "Having had laparoscopic surgery myself, and as a laparoscopic surgeon, I can tell you there are no scars within six months to a year of the operation," Hunter tells WebMD. "To suggest laparoscopy is scarring and NOTES isn't is not accurate."

    Hunter also questions whether recovery time is truly longer with minimally invasive surgery than for NOTES.

    Hunter's editorial comments accompany the Marescaux report in the Archives of Surgery.

    "The benefits of NOTES are not earthshaking and the risks are real," he writes. "Marescaux and colleagues. You have (again) put man on the moon. Now we need to figure out if there is any reason to populate this new plane."

    Hunter is all too aware of how this makes him sound. As a young surgeon advocating minimally invasive surgery, he remembers being told by older surgeons that he was wasting his time.

    "They said laparoscopy would never fly -- and they were completely wrong," he remembers.

    While Hunter doesn't think that NOTES will end up being the best way to perform gallbladder operations, he does see ways the technique could, in the future, improve a number of surgical procedures.

    "There is a lot of great opportunity here," he says. "I don't see NOTES as revolutionary. It might be incrementally better for some things. It is evolution rather than revolution at this point."

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