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The Role of Scarless Procedures in Urology: A Review of Literature

Kahie AA

Aga Khan University Hospital, Nairobi

Correspondence to: Dr. Aideed A Kahie, P.O Box 15301-00100 Nairobi, Nairobi.

Email: aideed@kaatun.com


The popularity of natural orifice transluminal endoscopic surgery (NOTES) or ‘scarless” surgery has been steadily increasing in the recent urological literature, as a new surgical intervention to access intra-peritoneal organs. NOTES comes with the promise of both scar less and painless postoperative procedures. It utilizes one or more patent natural body orifices with the intention to penetrate a hollow viscous to access the abdomen. It is believed to be the natural progression of laparoscopy, although currently available tools or instruments do not permit a holistic NOTES procedure. There are considerable limitations to the retraction of organs, bleeding control, and handling of instruments with this method. For this reason, the ‘hybrid’ technique, where a luminal approach is combined with abdominal ports is currently gaining ground. This technique may be the preferred choice for living donor nephrectomy in high volume centers. As a relatively novel procedure, not many studies exist comparing the relative advantages of NOTES over conventional laparoscopy. An assessment of the existing literature on this technique, as pertains to urology, has been undertaken in this article.


Keywords: Natural Orifices Transluminal Endoscopic Surgery, NOTES, Scarless Surgery, Urology

Ann Afr Surg. 2016;13(1):24-28


The development of minimal access surgery (MAS) over the past two decades has eclipsed many traditional open operations. MAS has reduced morbidity, enabled early return to normal activities and has improved scar appearance (1,2). In a bid to optimize these gains, further reduce the impact of surgical trauma and to enhance cosmesis, a scarless intervention has emerged. In this technique, the peritoneal cavity is entered without abdominal wall violation, and the procedure completed with no appreciable abdominal scar (3). This marked the birth of natural orifice transluminal endoscopic surgery (NOTES).

NOTES utilizes the natural openings of the body and the luminal viscous. Piercing the viscous allow access to the target organ in the abdominal cavi