Transgastric NOTES: Current Experience and Potential Implications for Urologic Applications

Abstract

Natural orifice translumenal endoscopic surgery (NOTES) in its current form uses flexible endoscopy technology to perform surgical procedures in the abdomen. NOTES is emerging as a potential alternative to both open and laparoscopic surgery, and the technique eliminates the requirement of abdominal incisions. To date, multiple intraperitoneal procedures have been reported in animal models while only a few reports of NOTES performed in humans exist. Several potential advantages of NOTES include the elimination of visible scars, less postoperative pain, and the reduction of postoperative complications, such as wound infection, abdominal wall pain, hernias, and adhesions. Current clinical applications of NOTES that are being studied heavily include its use in percutaneous endoscopic gastrostomy tube rescue and diaphragmatic pacing in intensive care unit patients. A number of barriers still exist regarding the technical challenges of transgastric NOTES, including access to the peritoneal cavity, the need for endoscope retroflexion for upper abdominal procedures, and endoscopic closure of the gastrotomy. The application of transgastric NOTES in urology has been limited to case reports in the porcine model, and no urologic procedure has been performed solely through a transgastric route. This article discusses the rationale of transgastric NOTES, its potential advantages and disadvantages, past and present work performed, current clinical applications, and its potential use in the future of urology.

Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

“…Thus far, NOTES has been successfully completed experimentally via transgastric [15], transvaginal [16], transcolonic [17], and transvesical [18] routes (Table 1). Kalloo et al demonstrated the feasibility of transgastric access to the peritoneal cavity in a porcine model [5].…”

“…Thus, the ideal telescope for LESS should remove the light cord and camera head from the operative field. Low-profile camera systems have been introduced for this purpose [15,[30][31][32].…”

Pure transvesical NOTES uterine horn resection in swine as an appendectomy model

“…Without reliable gastric closure, clinicians remain concerned about postoperative leakage, fistula formation, intraperitoneal contamination, and infection. In addition, the use of the flexible endoscopic platform, as well as problems relating to specimen retrieval, have limited the application of transgastric NOTES [11]. Recently, the transvaginal approach received attention.…”

Pure NOTES Transvesical Venous Ligation: Translational Animal Model of Varicocelectomy

“…Reliable endoscopic gastric closure technique must be developed and improved. 19 As all other cavities were explored, the first conclusion we made was that lower abdominal ports might be better for upper abdominal procedures and useful as an accessory port for transgastric access.…”