What endoscopic accessories do we really need?

This article is a speculative essay that reviews the current limitations of existing flexible endoscopic accessories. Suggestions are offered on future developments that may change endoscopic practice as it adopts an increasingly therapeutic role. There may be a potential for development in flexible endoscopic surgical techniques that will be comparable to those seen in rigid laparoscopic surgery. Low and high technology solutions are considered. Invention, common sense, and engineering efforts are needed to take flexible endoscopic surgery to a higher level of functional efficacy.