Recent advances of natural orifice transluminal endoscopic surgery in urological surgery

Abstract

Abbreviations & AcronymsAbstract: Natural orifice transluminal endoscopic surgery designates a surgical procedure that utilizes one or more patent natural orifices of the body with the intention to puncture a hollow viscera in order to enter the abdominal cavity. First carried out at the beginning of the 2000s in experimental models, it can be considered the natural evolution of laparoscopy towards the ideal of scarless surgery, as the avoidance of a large abdominal scar is associated with better cosmetic results and better recovery. However, the technology currently available does not allow the performance of complete pure natural orifice transluminal endoscopic surgery procedures. The surgical tools used are not specially designed for this approach, so difficulties in retracting organs, bleeding control and clashing of instruments are the main obstacle surgeons face. For this reason, the current available technique is the so-called hybrid approach, where a natural orifice approach is combined with some abdominal trocars, using the natural orifice as the exit door for the specimen removal. As not many comparative studies have been published evaluating the advantages of natural orifice transluminal endoscopic surgery in front of traditional laparoscopic surgery, a review of the history of natural orifice transluminal endoscopic surgery, and an assessment of the available evidence of this technique regarding renal and urological pelvic surgery are performed in this article.

Advances in laparoscopic surgery in urology

“…Moreover, the angle of the surgeon to the video monitor is critical for obtaining the optimal 3D image. A major disadvantage of the 30° endoscope is that it cannot be turned upside down to improve image angles when performing urethrovesical anastomosis or sacrocolpopexy (TABLE 1), but flexible 3D or high definition endoscopes can aid laparoscopic sigmoid ectomy or natural orifice transluminal endoscopic surgery (NOTES)assisted transvaginal nephrectomy, as they can be adapted to the enlarged working field 11 .…”

Editorial Comment to Recent advances of natural orifice transluminal endoscopic surgery in urological surgery

“…This article presents recent information on hybrid natural orifice transluminal endoscopic surgery (NOTES)‐assisted nephrectomy, which seems to be more practical and safe than pure NOTES . Potential advantages of NOTES are the lack of skin incisions and reduced pain despite its high degree of technical difficulty.…”