Laparoscopic-assisted endoluminal hybrid surgery: a stepping stone to NOTES.

Background: Natural orifice transluminal endoscopic surgery (NOTES) is the anticipated progression of minimally invasive surgery. As it approaches, surgeons will need to develop the fundamental skills and spatial orientation needed to perform safely in this new field. The Natural Orifice Surgery Consortium for Assessment and Research has established several fundamental challenges to the safe introduction of NOTES.