Natural Orifice Translumenal Endoscopic Surgery (NOTES) in urology

The concept of endoscopic surgery performed through natural orifices - Natural Orifice Translumenal Endoscopic Surgery (NOTES) - represents one of the most exciting ideas recently introduced in surgery. The use of natural orifice as a transluminal access to the peritoneal cavity has been shown to be effective and reproducible. After the introduction of the transgastric access (2004), the adaptation of the well-known transvaginal access, looking for ideal and more suitable entrance has led to the development of the transcolonic and transvescical ports. To date, the NOTES technique showed its full potential in experimental models, so as to allow the completion of most of the standard procedures performed in laparoscopic technique and thus opening the door to a new era, considered as "3rd generation surgery". However, only few experiences have been translated to humans and this concept is still at an early stage of experimental development. Many efforts are still needed to establish the standardization and validation of the techniques, the verification of safety and effectiveness. ?This article intends to photograph the actual role of NOTES, reviewing its history, analyzing the potential benefits and drawbacks, browsing and comparing the different transluminal routes, describing the equipment and platforms currently available, and finally to point out the state of the art of NOTES in the urological field.