Transcolonic NOTES: Current Experience and Potential Implications for Urologic Applications

There has been a progressive evolution in the field of surgery over the past 100 years-from the invasive open laparotomy to increasing less invasive techniques of laparoscopy. Conversely, the field of gastrointestinal endoscopy has witnessed a surge in increasingly more interventional techniques, previously only in the realm of gastrointestinal surgery, such as transgastric pseudocyst drainage and transgastric endoscopic pancreatic debridement. Natural orifice translumenal endoscopic surgery (NOTES) may represent a convergence and collaboration of the two fields and a paradigm shift in the concepts of both minimally invasive surgery and interventional endoscopy. NOTES involves performance of intra-abdominal surgical procedures via an incisional opening through a natural orifice (mouth, anus, vagina, or urethra). Although early studies focused on the transgastric approach, there has been increasing numbers of NOTES procedures reported via the transcolonic, transvaginal, and transvesical approach. While further research needs to be undertaken to evaluate the feasibility, safety, and applicability of NOTES in a clinical setting, it has the potential to become an integral facet of minimally invasive intra-abdominal surgery in the future. In particular, given the trend in urology toward increasing minimally invasive techniques, NOTES embodies the next incremental step needed to further reduce patient morbidity and procedural trauma in urologic interventions. This article will explore the transcolonic approach to the peritoneal cavity.