The skill sets of laparoscopy, endoscopy, robotics and even interventional cardiology are all converging to create least invasive surgeries that take laparoscopy as a point of departure but change how surgeons access the abdominal cavity. Start-ups are innovating to supply the new surgical instruments.

Minimally invasive surgery, performed through a number of ports to create access and enable visualization, manipulation, and dissection, promised to revolutionize surgical techniques two decades ago, but ultimately fell short of changing the way surgeons perform the majority of surgical cases. Now, the next generation in minimally invasive surgery sees single-port surgeries and natural orifice transluminal endoscopic surgeries (NOTES) gaining momentum. TransEnterix aims to operate in both cases, with a novel approach that not only allows surgeons greater dexterity in performing complex procedures, but also enables them to do surgical cases through a single access port, using the body's umbilicus

NOTES is an experimental alternative to conventional surgery that uses a combination of endoscopic and laparoscopic techniques to access the peritoneal cavity through the wall of the alimentary canal or other natural orifices, allowing surgeons and gastroenterologists to perform complex surgery without leaving any visible scars. In the last few years, NOTES research, procedures, patents, and venture capital investment have increased exponentially. And although the field is still unproven, the rush to NOTES is being fueled by several important motivators, including the perceived advantages over conventional surgery, patient demand, and a worldwide market potential believed to range between $2 and $4 billion per year.