Natural orifice transluminal endoscopic surgery in urology: Review of the world literature

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) has gained momentum in the recent urologic literature as a new surgical approach for intra-abdominal organs with scarless and painless postoperative recoveries. We sought to review the published literature concerning the safety and reproducibility of NOTES in urology. PubMed literature review of articles published in the English language was performed over a 10-year period, i.e., between 2001 and 2011; all articles were critically reviewed and analyzed. Despite its novelty, pure or hybrid surgical approaches have been adapted in performing NOTES. NOTES essentially utilizes transluminal flexible endoscopic instruments along with laparoscopic instruments to gain access to abdominal, pelvic, and/or retroperitoneal cavities. The preliminary results of NOTES in surgery and to a limited extent in urology appear promising, yet further research in animal survival and human cadaveric models is requisite prior to human applications, especially for complex surgeries. Future innovative research, particularly biomedical engineering, should be directed to improving the technicality and mechanistic application of NOTES; hence, better safety and efficacy of NOTES.

Keywords: Natural orifice transluminal endoscopic surgery; urology; world literature.

Figure 1

Flexible endoscope utilized in NOTES procedure (right image) and laparoscopic view of endoscope with snare (left image)

Figure 2

Creating submucosal rectal tunnel (right image) and surgical approach with transrectal trocar (left image)

Figure 3

Intraoperative laparoscopic view of dissecting forceps during NOTES procedure

Figure 4

Rectal extraction of specimen (right image) and rectotomy closure (left image)