TY - JOUR
T1 - Natural orifice translumenal endoscopic surgery (NOTES) in urology
T2 - Initial experience
AU - Gettman, Matthew T.
AU - Cadeddu, Jeffrey A
PY - 2008/4/1
Y1 - 2008/4/1
N2 - Background and Purpose: 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.
AB - Background and Purpose: 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.
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U2 - 10.1089/end.2007.9825
DO - 10.1089/end.2007.9825
M3 - Article
C2 - 18366321
AN - SCOPUS:42249091508
SN - 0892-7790
VL - 22
SP - 783
EP - 788
JO - Journal of endourology
JF - Journal of endourology
IS - 4
ER -