This is borne out in our data where 81% of patients felt that research into NOTES held some level of importance. One of the groups in the customer reviews position to benefit the most from NOTES is obese patients, though our data show that level of interest in the technique is significantly and negatively associated with BMI, such that those of healthy weight expressed greater interest. Obese patients are especially at risk for hernias after transabdominal surgery [4�C6] and NOTES could mitigate this risk. The lack of abdominal wall incisions could also lead to earlier postoperative mobilization, better lung ventilation, decreased wound infections, all of which would lead to decreased length of hospital stay [12]. Furthermore, NOTES-assisted bariatric surgery has now been successfully attempted [14] and in the authors’ opinion is one of the prime areas for NOTES development.

Hence, further objective data and education will be necessary to garner the interest and support of this population in this new technique. Though the capital investment required for the development and adoption of any new technique is significant, the potential for cost savings in projected shorter hospital stays could offset the cost. Ninety-five percent of patients indicated that a shorter in-hospital stay was important to them, adding to the attractiveness of this aspect of NOTES. The reasons behind patient interest in shorter length of hospital stay were not explored further but could include less time away from home and increased awareness of hospital acquired infections.

Third party payers (insurance companies and governments) would certainly also be interested in a technique that reduces hospital stay. In addition, it has been proposed that once further developed NOTES would not require a traditional operating room, thus altering hospital utilization further [15]. The current study has some limitations. By dint of the survey population being from surgical clinics, a large proportion already had scars, which may have skewed the results. While the self-administered survey prevented any bias that might have stemmed from a personal interview, patients were unable to ask for any more detail regarding the technique and complications than was included in the survey. For example, when presented with potential complications such as dyspareunia and infertility, women may in fact be less interested in the transvaginal approach of NOTES. Qualitative data collection may provide more insight into the subtleties of patient concerns. This Brefeldin_A could also be extended to multiple centres to capture regional differences in opinion as the present study was performed in a single centre. Our results show that there is significant Canadian patient interest in NOTES.