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Jacques Marescaux, MD, FRCS; Bernard Dallemagne, MD; Silvana Perretta, MD; Arnaud Wattiez, MD; Didier Mutter, MD, PhD; Dimitri Coumaros, MD

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In reply

We thank Dr Hall for his comments on the future of NOTES. However, we believe it is too early to conclude that transluminal cholecystectomy is not as safe as laparoscopic cholecystectomy. We all remember the similar judgments given during the description of the first laparoscopic cholecystectomy. Our article does indeed ask what the rationale is behind the incision of a generally healthy hollow organ, whether it should be incised, and what the risks are related to this opening.

During a transgastric or transcolonic approach, the 0.25% chance of fistulas to which Dr Hall referred are indeed unacceptable during surgery for benign conditions. Tolerance has to be close to 0. Numerous research programs aimed at finding technical solutions that would allow us to approach the tolerance threshold are currently . . . [Full Text of this Article]

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