Transvaginal NOTES Nephrectomy

Over the last 20 years, surgery has changed dramatically, from open to laparoscopic and more recently new minimally invasive techniques like laparoscopic single-site surgery (LESS) and natural transluminal endoscopic surgery (NOTES). The current goal with those techniques is to reduce morbidity and improve cosmetic results while maintaining functional and oncological results. Natural orifice transluminal endoscopic surgery uses natural orifices to enter the abdominal cavity avoiding abdominal incisions becoming a scarless surgery technique. NOTES was performed for the first time in animal models at the beginning of the 2000s and posteriorly has been applied in different experimental procedures and in some surgeries in humans, but this technique has not experimented the same acceptance than laparoscopy. NOTES, especially pure NOTES, increases complexity in comparison to laparoscopic approach and even over LESS (Fig. 11.1).