Despite the great enthusiasm in NOTES surgery, the encountered limitations of endoscopic instrumentation diminished the number of feasible surgical procedures.
Several prototypes are being developed for endoscopic retraction and exposure as well for suturing, for the achievement of simple procedures in the digestive, gynecologic or urological field, in animal models.
A real engagement is needed in the evolution of these tools, as they will be key to the future of NOTES and endolumenal procedures.