Consensus Statement on Natural Orifice Transluminal Endoscopic Surgery and Single-Incision Laparoscopic Surgery: Heralding a New Era in Urology?

Gettman, Matthew T.; Box, Geoffrey N.; Averch, Timothy D.; Cadeddu, Jeffrey A.; Cherullo, Edward E.; Clayman, Ralph V.; Desai, M. M.; Frank, Igor; Gill, I.; Gupta, Mantu; Haber, Georges Pascal; Humphreys, Mitchell R.; Kaouk, Jihad; Landman, Jaime; Lima, Estêvão; Ponsky, Lee

doi:10.1016/j.eururo.2008.02.006

Cited by 139 publications

(88 citation statements)

References 25 publications

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“…Unfortunately, the quality of evidence of all available studies remains low, mostly being small case series [61][62][63] (evidence level 4) or case-control studies from selected centers [64][65][66][67][68][69][70][71] (evidence level 3b). Given the limited amount of data, available reviews are narrative [11,13,14,[29][30][31]78,79] or are based on expert opinions and consensus meetings [1,2,80] (evidence level 4). Thus far, the advantages of LESS still exist at a theoretical level, because no clear benefit on postoperative course and patient convalescence has been definitively proven.…”

Section: 4mentioning

confidence: 99%

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Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

et al. 2011

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LESS Natural orifice transluminal endoscopic surgery NOTES Robotics UrologyPlease visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery. Objective: To summarize and critically analyze the available evidence on the current status and future perspectives of LESS and NOTES in urology. Evidence acquisition: A comprehensive electronic literature search was conducted in June 2010 using the Medline database to identify all publications relating to NOTES and LESS in urology. Evidence synthesis: In urology, NOTES has been completed experimentally via transgastric, transvaginal, transcolonic, and transvesical routes. Initial clinical experience has shown that NOTES urologic surgery using currently available instruments is indeed possible. Nevertheless, because of the immaturity of the instrumentation, early cases have demanded high technical virtuosity. LESS can safely and effectively be performed in a variety of urologic settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low, mostly being small case series or casecontrol studies from selected centers. Thus, the only objective benefit of LESS remains the improved cosmetic outcome. Prospective, randomized studies are largely awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technology advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics is likely to drive a major paradigm shift in the development of LESS and NOTES. Conclusions: NOTES is still an investigational approach in urology. LESS has proven to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons. Development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.

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Section: 4mentioning

confidence: 99%

“…Conceptually, these techniques share a common underlying ''hypothesis'' that has driven their development-namely, that a reduction in the number of transcutaneous points of access may benefit patients in terms of port-related complications, recovery time, pain, and cosmesis by potentially performing scarless surgery [1].…”

Section: Introductionmentioning

confidence: 99%

Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

et al. 2011

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“…1 With the aim of preventing port-site complications, further decreasing discomfort associated with laparoscopic surgery, and improving cosmesis, natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have recently been developed. 2 The term 'NOTES' was first formally introduced by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR), a joint initiative supported by the American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). 3 The central tenets of NOTES involve the intentional puncture of one of the viscera (e.g.…”

Section: Introductionmentioning

confidence: 99%

Current status and future perspectives in laparoendoscopic single‐site and natural orifice transluminal endoscopic urological surgery

et al. 2010

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Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been succesfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

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“…[1] NOTES is still in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. However, this remains a field of intense clinical and experimental research in various surgical specialties.…”

Section: Introductionmentioning

confidence: 99%

The transrectal single port laparoscopic radical prostatectomy in a cadaver model

Akça¹,

Zargar²,

Autorino³

et al. 2015

Turkish Journal of Urology

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Objective: To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. Material and methods:After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT ® Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT ® Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. Results:Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. Conclusion:Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.

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Consensus Statement on Natural Orifice Transluminal Endoscopic Surgery and Single-Incision Laparoscopic Surgery: Heralding a New Era in Urology?

Cited by 139 publications

References 25 publications

Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

Current status and future perspectives in laparoendoscopic single‐site and natural orifice transluminal endoscopic urological surgery

The transrectal single port laparoscopic radical prostatectomy in a cadaver model

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