Techniques for Transanal Access to the Peritoneal Cavity

Natural orifice translumenal endoscopic surgery (NOTES) represents a burgeoning but still largely experimental field. For surgeries involving the upper abdominal organs, the transanal approach promises to provide a more direct route in contrast to the often cumbersome retroflexion typically required with the transgastric approach. The potential disadvantages of the transanal route are also significant and include issues of sterility, the risk of inadvertent trauma to adjacent organs during transmural puncture, and the risk of colonic wall shearing. This article reviews the evolution of transanal access to the peritoneal cavity, highlights the various techniques that have been used for transanal access and closure, and discusses in further detail the relative advantages and disadvantages of this approach.