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Background: The role of transoral robotic surgery (TORS) in the treatment of head and neck tumors has expanded in the last decade., Objectives: We present the development and current advances in TORS along with the current indications and contraindications, and describe future developments., Methods: We present our own studies and review those in the literature., Results: Since approval of the da Vinci® system, the number of TORS cases has increased significantly. The main indications are tumors of the oropharynx and supraglottis. Most published studies are retrospective case series with no control group. In addition to the further development of the da Vinci® system, the introduction of the Flex®-system is a significant progression. The costs of using robotic systems are high., Conclusions: Technical improvement of robotic systems and the development of new surgical techniques will further expand the indications for TORS. The value of TORS needs to be assessed in prospective controlled studies.

Background: The German NOTES registry (GNR) was initiated by the German Society for General and Visceral Surgery (DGAV) as a treatment and outcome database for natural orifice transluminal endoscopic surgery (NOTES)., Aim: The aim of this study was the descriptive analysis of all GNR data collected over a 5-year period since its start in 2008 with more than 3000 interventions., Material and Methods: The GNR is an online database with voluntary participation available to all German-speaking clinics. Demographic data, therapy details, complications and data on the postoperative course of patients are recorded. All cases in the GNR between March 2008 and November 2013 were included in the analysis., Results: From a total of 3150 data sets 2992 (95 %) were valid and suited for the analysis. Hybrid transvaginal cholecystectomy was the most frequently used procedure (88.7 %), followed by hybrid transvaginal/transgastric appendectomy (6.1 %) and hybrid transvaginal/transrectal colon procedures (5.1 %). Intraoperative complications occurred in 1.6 %, postoperative complications in 3.7 % and conversions were reported in 1.5 %. Intraoperative bladder injuries and postoperative urinary tract infections were identified as method-specific complications of transvaginal procedures. Bowel injuries occurred as a rare (0.2 %) but potentially serious complication of transvaginal operations., Conclusion: The German surgical community ensures a safe and responsible introduction of the new NOTES operation techniques with its active participation in the GNR. Despite an overall low complication rate, the high number of procedures in the GNR permitted the identification of method-specific complications. This knowledge can be used to further increase the safety of NOTES in practice.

The past few years have seen a shift in focus for endoscopy research. For example, there has been a halt in the apparent revolution of natural orifice transluminal surgery (NOTES), which was long considered the most important innovation in flexible endoscopy. Other trends such as endoscopic histology are slowing down and not progressing into clinical practice. In general, the quality of endoscopic research needs to be improved, particularly in the field of diagnostics and imaging 1. Nevertheless, progress in some areas continues, albeit at a slower pace than we might like. In this review the areas of current interest are reviewed with reference to the most relevant areas of progress in recent years., (© Georg Thieme Verlag KG Stuttgart · New York.)

"Scarfree" surgery is a desired goal in the world of laparoscopy and interventional endoscopy. One possibility to achieve this goal is abdominal access via a natural orifice (natural orifice transluminal endoscopic surgery, NOTES); however, this procedure and its applications lack an appropriate platform. Further possibilities are reduced port techniques or single port access surgery, which result in minimal scarring. Development and continued growth in this area cover a broad spectrum. Although acceptance has been demonstrated, the technique must be adopted in a safe and effective manner and must be economically and ecologically safe. This article gives an overview of the development of the technique, the learning curve, and new applications for this new technique. An English full-text version of this article is available at SpringerLink as supplemental.

The tremendous increase in medical knowledge over the last decades and technical progress in medicine have caused further professional specialization. Numerous medical fields have evolved through the process of separation from the parent specialization and the traditional distinction between surgical and medical disciplines has been blurred. As a result of this development organ-specific interdisciplinary units have been formed and new partners have united, such as surgeons and gastroenterologists in the field of interventional endoscopy. The fading boundaries brought with them resistance and even resentment and called for a mutual regulation by the professional associations which took place 10 years ago. Nowadays, surgeons and gastroenterologists in Germany are trained in interventional endoscopy and are the foundation of endoscopic interdisciplinary teamwork in emergency care, diagnostics, therapy, complication management and palliative treatment. Technical innovations striving for a minimization of operative trauma like NOTES depend on the cooperation of both fields of expertise. The driving force behind these efforts should be the shared interest in further improvement of patient care at the highest level of individual expertise, patient-oriented process optimization and adequate use of resources.