Technical skill set training in natural orifice transluminal endoscopic surgery: how should we approach it?

Background: The boundaries in minimally invasive techniques are continually being pushed further. Recent years have brought new and exciting changes with the advent of natural orifice transluminal endoscopic surgery. With the evolution of this field of surgery come challenges in the development of new instruments and the actual steps of the procedure. Included in these challenges is the idea of developing a proficiency-based curriculum for training.
Methods: A review of the currently available literature was performed to support the points discussed.
Results: In this article we address and discuss the issues of who, when, where, and how to teach suitable trainees in the technique of natural orifice transluminal endoscopic surgery.
Conclusion: What comes to the fore is the importance of providing safe and structured training in these techniques.