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NOTES Procedure

Natural orifice transluminal endoscopic surgery (NOTES): where are we going? A bibliometric assessment

Riccardo Autorino*†, Rachid Yakoubi*, Wesley M. White‡, Matthew Gettman§, Marco De Sio†, Carmelo Quattrone†, Carmine Di Palma†, Alessandro Izzo†, Jeorge Correia-Pinto¶, Jihad H. Kaouk* and Estevão Lima¶

*Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA, †Urology Unit, Second University of Naples, Naples, Italy, ‡Division of Urologic Surgery, University of Tennessee, Knoxville, TN, and §Department of Urology, Mayo Clinic, Rochester, MN, USA, and ¶Life and Health Sciences Research Institute, University of Minho, Braga, Portugal

The aim of this study was to analyse natural orifice transluminal endoscopic surgery (NOTES)-related publications over the last 5 years. A systematic literature search was done to retrieve publications related to NOTES from 2006 to 2011. The following variables were recorded: year of publication; article type; study design; setting; Journal Citation Reports® journal category; authors area of surgical speciality; geographic area of origin; surgical procedure; NOTES technique; NOTES access route; number of clinical cases. A time-trend analysis was performed by comparing early (2006–2008) and late (2009–2011) study periods. Overall, 644 publications were included in the analysis and most papers were found in general surgery journals (50.9%). Studies were most frequently clinical series (43.9%) and animal experimental (48%), with the articles focusing primarily on cholecystectomy, access creation and closure, and peritoneoscopy. Pure NOTES techniques were performed in most of the published reports (85%) with the remaining cases being hybrid NOTES (7.4%) and NOTES-assisted procedures (6.1%). The access routes included transgastric (52.5%), transcolonic (12.3%), transvesical (12.5%), transvaginal (10.5%), and combined (12.3%). From the early to the late period, there was a significant increase in the number of randomised controlled trials (5.6% vs 7.2%) or non-randomised but comparative studies (5.6% vs 22.9%) (P < 0.001) and there was also a significant increase in the number of colorectal procedures and nephrectomies (P = 0.002). Pure NOTES remained the most studied approach over the years but with increased investigation in the field of NOTES-assisted techniques (P = 0.001). There was also a significant increase in the adoption of transvesical access (7% vs 15.6%) (P = 0.007). NOTES is in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. Since the first description of the concept of NOTES, >2000 clinical cases, irrespective of specialty, have been reported. NOTES remains a field of intense clinical and experimental research in various surgical specialities.

Autorino R, Yakoubi R, White WM, et al. Natural orifice transluminal endoscopic surgery (NOTES): where are we going? A bibliometric assessment. BJU Int 2013; 111: 11–16

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