I have mixed feelings about this. I think we have all seen skilled surgeons who despite the innovation of laparoscopy, still have to convert to open - either because of an injury during the procedure, or more commonly, because you just can't see what you need to see with the scope. This usually isn't a function of the equipment but rather patient anatomy, so I can't see that factor changing much.
NOTES is pretty exciting stuff but it will take some time before the procedure becomes accepted in the medical community, enough people get training and the public accepts it (outside of accepting it because its "SCARLESS SURGERY!!!). It took laparoscopy awhile, so it may be 15-20 years before NOTES becomes commonplace.
Although rib spreaders aren't very commonly used in appys, they come in quite handy in the chest, especially in the trauma bay. Given the amount of time it takes to set up a laparoscopic procedure, I can't see a knife and Finochietto being replaced in that scenario anytime soon. There will still be things in which having your hands on the tissue beats scopes anyday.
