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

Abstract

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.

Public Perception of “Scarless” Surgery: A Critical Analysis of the Literature

“…However, serious questions remain regarding its pragmatism outside of centers of excellence. 7 Even more experimental and technically challenging is the concept of natural orifice translumenal endoscopic surgery (NOTES). [8][9][10] NOTES uses transgastric, transvesical, transcolonic, and/or transvaginal access to approach the peritoneal cavity and organ of interest.…”

“…Thus far, reports of successful NOTES procedures remain anecdotal, and the use of this technique is still investigational. 7 Laparoscopic cholecystectomy was introduced in the late 1980s and embraced by a minority of surgeons. Early studies showed that laparoscopy resulted in little patient benefit, increased cost, and potential harm to patients.…”

Simple nephrectomy in a young woman for recurrent pyelonephritis utilizing laparoendoscopic single-site surgery (LESS)

“…A recent review of the literature found the only objective benefit of LESS appeared to be cosmetic, while recognizing the poor quality of currently available evidence. 6 However, it would be reasonable to expect an improvement in certain measures due to using a single incision. The ease of the LESS technique may also improve with the continued refinement and miniaturization of the instrumentation coupled with the rapid development of robotic surgery.…”

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

“…However, RALP needs five to seven ports and one 4-5cm wound is necessary. Interest has therefore focused on reducing the number of ports and in fact several reports of laparoendoscopic single site surgery (LESS) in the urological speciality have appeared in the literature Hidetoshi Akita 1 , Akihiro Nakane 1 , Ryosuke Ando 1 , Kenji Yamada 1 , Takahiro Kobayashi 1 , Takehiko Okamura 1 *, Kejiro Kohri 2 (Castellucci et al, 2008;Desai et al, 2008;Aron et al, 2009;White et al, 2009;Autorino et al, 2011;2012). Nevertheless, even with the use of laparoscopic curved or articulating instruments, significant 'clashing' with both the camera and other instruments can increase operative times and require significant laparoscopic skills especially for intracorporeal suturing.…”