One of the most recent trends in laparoscopic surgery is to access the peritoneal cavity via the umbilicus using a single skin incision. Single-incision laparoscopy introduces additional constraints to the conventional laparoscopic environment and requires surgeons to use new flexible and articulating instruments and novel access platforms. Over the past two years, medical device companies have been racing to develop enabling technologies for single-incision laparoscopy, but the approach is controversial and its future appears uncertain as surgeons debate the cost/benefits of the single-incision laparoscopic approach.

The predicted expansion of beating-heart and minimally-invasive cardiac surgery never materialized, a result, some say, of the lack of safe and effective automated anastomotic tools. Cardica believes it has the answer that can at long last grow this market.

There was an almost dot-com-like euphoria about NOTES at 2007's annual meetings of endoscopists and surgeons. NOTES (natural orifice translumenal endoscopic surgery) is being described as a revolution in minimally invasive surgery, incisionless surgery, or at the very least, a major advance over laparoscopy. It represents a billion-dollar category not yet dominated by the companies that gained preeminence in the $4 billion worldwide laparoscopy market. But most companies in the area agree that the NOTES revolution isn't going to happen overnight. The challenge for today is to create products and technologies for procedures that can happen in high volume in the near term, while waiting for more advanced NOTES procedures to come about.

Laparoscopic surgeons see Natural Orifice Transluminal Endoscopic Surgery ( NOTES) as next decade's revolution. In the near term, they believe that single-port surgery, which uses the navel the point of entry for all laparoscopic tools, is the next logical step in minimally invasive surgery. It enables surgeons to be even less invasive than current procedures, and patients like invisible scars. We take an early look at the emerging field of single port surgery.