NOTES: a gastroenterologist's perspective.

Once in a few decades in science or medicine, an idea emerges that is so powerful that it changes forever how we think about the field. Such is the case of natural orifice transluminal endoscopic surgery (NOTES). NOTES has yet to prove its value in patients. However, having challenged one of the most fundamental and deeply entrenched dogmas in surgery and endoscopy, many of us feel that "we will never be the same again." In this article I will discuss the implications of this paradigm shift and suggest strategies for both gastroenterologists and surgeons that will allow us to test its full potential.