Nephrectomy and natural orifice translumenal endoscopy (NOTES): transvaginal, transgastric, transrectal, and transvesical approaches.
This paper outlines recent developments in the field of natural orifice translumenal endosurgery (NOTES) in urology and nephrectomy from the perspective of a flexible endoscopist. The history of transvaginal extraction of kidney specimens using rigid laparoscopic instruments and early studies of transvaginal nephrectomy as a precursor of NOTES are reviewed. Transgastric approaches to nephrectomy using flexible instruments and transvesical hybrid approaches to nephrectomy and other intra-abdominal procedures including cholecystectomy and transvesical lung biopsy are outlined, as are other experimental approaches including transrectal kidney removal. The paper reviews the rationale for a NOTES approach to abdominal surgery and discusses recent human studies. The limitations of NOTES and need for better instrumentation and more studies are stressed.
Swain
Paul
P
Imperial College, London University, Department of Surgical Oncology and Technology, London, U.K. PaulSwain1@compuserve.com
D000818:Animals; D004724:Endoscopy / Q000639:trends*; D006801:Humans; D009392:Nephrectomy / Q000639:trends*