Natural orifice transluminal endoscopic surgery (NOTES): current experience and urologic applications

Natural orifice transluminal endoscopic surgery (NOTES) has attracted considerable recent attention for its potential to allow traditional abdominal procedures to be performed without a transabdominal incision. With considerable experience in the development and application of minimally invasive techniques, urologists have played a significant role in early experimental NOTES efforts and have contributed to early investigations in human subjects accordingly. However, adoption of these techniques has been limited due to cumbersome endoscopic equipment and concerns regarding peritonitis from failed viscerotomy closure. Experience with use of NOTES in human subjects is limited, and studies comparing NOTES to conventional minimally invasive techniques are lacking. Until adequate endoscopes are developed to facilitate a pure NOTES approach, multiple portals of entry will be necessary to facilitate both urologic and non-urologic reconstructive and extirpative procedures. Our aim is to evaluate NOTES techniques, portals of entry, early clinical experiences, and the application of NOTES to urologic surgery.