While adrenal and kidney urological surgery has been performed in animal models mainly by transvesical accesses, to date, NOTES in humans remains in an investigational and developmental phase. Despite great experimental interest, no specific devices are currently available for urological indications in humans and therefore several instruments, taken from different specialist fields, have been used to access through the different natural orifices (including transgastric, transcolonic, transvaginal and transvesical approaches). Furthermore, the accumulating experience with the transvesical approach to the peritoneum suggests it presents new challenges for urologists in terms of technical demands. For these reasons, given their competition with the success of laparoscopy and minimally invasive techniques, NOTES applications in urology risk being underevaluated. In our opinion, after the initial enthusiastic phase, NOTES will cover only specific indications for urological conditions. The transvesical approach to the peritoneum however seems to be one of the best approaches for NOTES overall and certainly the most promising for urologists.
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