Natural orifice translumenal endoscopic surgery (NOTES) in urology: initial experience.
OBJECTIVE
For years, urologists have been champions of surgery performed through natural body openings. The next frontier is intraperitoneal or retroperitoneal surgery performed via natural body openings. We reviewed the initial experience with natural orifice translumenal endoscopic surgery (NOTES) in urology.


METHODS
The first experimental application of NOTES was published in 2002 when transvaginal nephrectomy was performed in the porcine model. Confirmatory experimental studies using the gastrointestinal tract for NOTES were first published in 2004. The bladder was first experimentally evaluated as a portal for NOTES in 2006. Urologists have developed and evaluated novel magnetic anchoring systems and operative platforms for NOTES. To date, clinical application of NOTES in urology is limited to transvesical peritoneoscopy.


RESULTS
Analysis of the literature suggests that technologic, anatomic, physiologic, ethical, and philosophical questions must be answered before NOTES will be widely introduced or justified clinically. The premise that NOTES will be associated with a better recovery and fewer postoperative risks also remains to be evaluated.


CONCLUSIONS
Largely in experimental models, urologists have show feasibility of NOTES. Ongoing evaluation and the introduction of new technologies are required for the field to advance. In addition, NOTES should be carefully embraced only after detailed evaluations prove a measured benefit in comparison to established minimally invasive techniques.
Gettman
Matthew T
MT
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA. gettman.matthew@mayo.edu
Cadeddu
Jeffrey A
JA
D002986:Clinical Trials as Topic; D004724:Endoscopy / Q000639:trends*; D006801:Humans; D014572:Urology / Q000295:instrumentation / Q000639:trends*