Transvesical NOTES: Current experience and potential implications for urologic applications

Tremendous attention and energy have been put toward development of minimally invasive techniques in urology to decrease the morbidity of surgery without compromising outcomes. Urologists have remained on the cutting edge of technology, performing procedures via laparoscopic, robotic, and transurethral approaches in procedures that were formerly only performed with an open approach. As the treatment paradigm shifts toward less invasive procedures, the concept of performing surgery through natural body openings has been recognized. Natural orifice translumenal endoscopic surgery (NOTES) eliminates the need for abdominal incisions, theoretically resulting in decreased pain, faster convalescence, improved cosmesis, and absence of wound infections and hernias. While transvesical NOTES has the potential to develop into a viable technology in the clinical setting, it is still in its infancy. Initial studies have demonstrated the feasibility of transvesical NOTES; however, further work must be dedicated to this subject before its routine application in humans. The purpose of this review is to detail the experimental, cadaveric, and clinical work that has been accomplished with transvesical NOTES, in addition to discussing the advantages and disadvantages, technical obstacles, and potential risks that accompany the use of the bladder as a portal for surgery.