Natural orifice transluminal endoscopic surgery (NOTES) is becoming of growing interest. Advantages of this procedure as no scar or minimal invasiveness are quite obvious. In Pediatric surgery a couple of procedures are done via natural orifices for example resecting aganglionic bowel in Hirschsprung’s disease (TransEndoRectalPullThrough, TERPT) or excision of polypes. Both procedures are quite advanced yet remain in some patients challenging. During the symposium the surgical steps of TERPT and of endoluminal polypectomie will be explained while presenting intra operative pictures. Additionally, obstacles and complications of both procedures will be explained. The question will be discussed whether the use of the newly developed endoscope might be applicable in order to perform NOTES for both diagnoses resulting in less complications for patients.
Also the application of the flexible endoscope which was presented at the Hamlyn symposium by Prof. Kwon in June 2017, as a more advanced diagnostic tool in Pediatric Surgery will be discussed.  During the seminar we would like to discuss a possible application for detecting fistulas in patients with an anorectal malformation (ARM) or for taking biopsies in patients suspect of Hirschsprung’s disease (HD) Therefore the clinical picture of ARM will be explained as well as the surgical procedure and challenges of the surgery. The necessary steps in detecting HD will be explained as well as diagnostic challenges for pathologist and pediatric surgeon for which the flexible endoscope might offer solutions.