Robotic NOTES (Natural Orifice Transluminal Endoscopic Surgery) in Adults: Limitations in the Pediatric Population

Over the last 30° years, laparoscopic surgery in the pediatric population has been increasingly utilized by pediatric urologists as a minimally invasive alternative to open surgery. With the goal of reducing the morbidity associated with open surgery, ever more complex surgeries have been completed with excellent outcomes, initially using the conventional laparoscopic method, and now with assistance from the da Vinci surgical robot. As laparoscopic techniques and technology continue to be developed and refined, pediatric urologists are beginning to employ even more minimally invasive approaches, including laparoendoscopic single-site (LESS) surgery and natural orifice transluminal endoscopic surgery (NOTES). The aim of this chapter is to describe the evolution of laparoscopic techniques and their application to the pediatric population, and also a discussion about the potential advantages of robotic NOTES (R-NOTES), and the limitations that make it a less viable option currently for the field of pediatric urology, until more appropriate instrumentation is developed.