The TEEM procedure is technically feasible. Due to the morbidity encountered in the first three pigs, the reported technique was modified to include a slimmer endoscope, a shorter tunnel, and a partial-thickness myotomy. These changes together with an understanding of the pitfalls involved in this procedure led to successful results for the next three pigs. Nevertheless, the authors believe that TEEM is not yet ready for prime time. Perfection of the technique and development of dedicated instruments are mandatory before safe translation of this method to human patients.

The miniature laparoscopic camera provides adequate images with enhanced visibility in conventional laparoscopic, SPS, and NOTES procedures. We believe that this device or similar miniature cameras may greatly aid the future development of NOTES and SPS by enhancing the safety and ease of performing these procedures. Further development is being conducted in order to integrate this camera into standard instruments and to allow an even better image quality.