Natural orifice translumenal endoscopic surgery (NOTES) in urology: initial experience

Area of Science:

• Urology
• Minimally Invasive Surgery
• Endoscopic Surgery

Background:

• Urologists have historically championed surgery through natural body openings.
• The advancement of natural orifice translumenal endoscopic surgery (NOTES) represents the next frontier in minimally invasive urological procedures.
• This review examines the initial experiences and potential of NOTES in urology.

Purpose of the Study:

• To review the initial experience and feasibility of natural orifice translumenal endoscopic surgery (NOTES) in urology.
• To explore the potential of NOTES for intraperitoneal or retroperitoneal surgery via natural body openings.
• To assess the current status and future directions of NOTES in the field of urology.

Main Methods:

• Review of experimental and clinical applications of NOTES in urology, starting from 2002.
• Examination of the use of transvaginal, gastrointestinal, and transvesical approaches for NOTES.
• Evaluation of novel magnetic anchoring systems and operative platforms developed for NOTES.

Main Results:

• Experimental applications of NOTES in urology began in 2002 with transvaginal nephrectomy in porcine models.
• The bladder was experimentally evaluated as a portal for NOTES in 2006.
• Clinical application of NOTES in urology is currently limited to transvesical peritoneoscopy.

Conclusions:

• Urologists have demonstrated the feasibility of NOTES, primarily in experimental models.
• Technological, anatomical, physiological, ethical, and philosophical questions require resolution before widespread clinical adoption.
• NOTES should be cautiously adopted only after rigorous evaluation proves clear benefits compared to established minimally invasive techniques.