New NOTES Clinical Training and Program Development

Ten years later, NOTES represents one of the most intense areas of surgical and GI research, and is arguably the most significant endoscopic innovation of this decade. POEM was the first NOTES offshoot out of which was borne the novel collection of new NOTES. The training pathway for new NOTES is a relatively long journey encompassing advanced endoscopy training, mastery of endoscopic dexterity within the narrow submucosal or "third space" with an in-depth understanding of the tissue planes through training in submucosal endoscopy. Proficiency with new closure and hemostatic devices is also essential. There are few institutions worldwide that can provide all the cognitive and technical elements essential to train new NOTES trainees. Hence, many trainees may need to spend time across several institutions to ensure safe and effective practice of new NOTES.