Transumbilical laparoscopic urological surgery: are special devices strictly necessary?

Branco, Aníbal Wood; Kondo, William; Stunitz, Luciano C.; Filho, Alcides José Branco; George, Marco Aurélio de

doi:10.1111/j.1464-410x.2009.08536.x

Cited by 16 publications

(11 citation statements)

References 33 publications

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“…Traditional rigid, straight instruments have also been used for LESS. Branco et al evaluated LESS urologic surgery using conventional laparoscopic instruments and ports, claiming that articulating instruments might be not strictly necessary [36].…”

Section: Instrumentsmentioning

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: Instrumentsmentioning

confidence: 99%

“…[46,68] Slightly difficult Lack of specifically designed cryoprobes. High Simple nephrectomy [11,12,33,35,36,39,40] Fairly difficult Besides cosmetic advantages, other benefits for the patient still need to be fully demonstrated.…”

Section: 4mentioning

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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“…In the last years, various efforts have been made to further minimize the invasiveness of traditional laparoscopy reducing the port size and/or the port number [2][3][4][5][6]. As a result of these efforts, single-port transumbilical laparoscopic surgery has been introduced as a further development of conventional laparoscopy.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the technical challenges associated with complex intracorporeal maneuvers, lack of instrument triangulation, limited traction of tissue, and external crowding and clashing [3,12], single-port laparoscopic surgery has been successfully performed by experienced groups in gynecologic surgery [1,[12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Single-port laparoscopic surgery in gynecology—current status

Kondo

Ribeiro²,

Zomer

2012

Gynecol Surg

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The objective of this study is to report the current status on single-port laparoscopic surgery in gynecology. A systematic MEDLINE review of the English language literature from 2007 to 2011 was performed using the search term "single-port surgery," which contained information on single-port laparoscopic surgery in gynecology. Overall, 1,152 patients (26 studies) were included in the analysis. The operative time varied according to the type of procedure. The conversion rate to conventional laparoscopy was 1.99 %, and the conversion rate to laparotomy was 0.35 %. Postoperative complications were encountered in 1.48 % of cases. Different gynecologic procedures have been effectively performed by means of single-port laparoscopic surgery. The procedure seems to be feasible, reproducible, and safe. Reduced pain and improved cosmesis are supposed to be the potential advantages of these procedures, but it was not completely confirmed yet! Further studies are still necessary to establish the real benefits of this new surgical approach over the traditional multi-port laparoscopy.

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“…Recently, many authors, including ourselves, have successfully described the role of the laparoendoscopic single-site surgery (LESS) by umbilical approach for urological pathologies (1)(2)(3)(4). The potential benefits are related to the minimization of skin morbidity (temporary incision pain and muscle spasms, avoidance of epigastric vessel injury) and the improved cosmesis.…”

Section: Introductionmentioning

confidence: 99%

Laparoendoscopic pfannenstiel nephrectomy using conventional laparoscopic instruments - preliminary experience

Branco¹,

Kondo²,

Stunitz³

et al. 2010

Int. braz j urol.

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Purpose: To confirm the feasibility of the laparoendoscopic Pfannenstiel nephrectomy using conventional laparoscopic instruments. Materials and Methods: Since March 2009, laparoscopic nephrectomy through a Pfannenstiel incision has been performed in selected patients in our service. The Veress needle was placed through the umbilicus which allowed carbon dioxide inflow. One 5 mm (or 10 mm) trocar was placed at the umbilicus for the laparoscope, to guide the placement of three trocars over the Pfannenstiel incision. Additional trocars were placed as follows: a 10 mm in the midline, a 10 mm ipsilateral to the kidney to be removed (2 cm away from the middle one), and a 5 mm contralateral to the kidney to be removed (2 cm away from the middle one). The entire procedure was performed using conventional laparoscopic instruments. At the end of the surgery, trocars were removed and all three incisions were united into a single Pfannenstiel incision for specimen retrieval. Results: Five nephrectomies were performed following this technique: one atrophic kidney, one kidney donation, two renal cancers and one bilateral renal atrophy. Median operative time was 100 minutes and median intraoperative blood loss was 100 cc. No intraoperative complications occurred and no patients required blood transfusion. Median length of hospital stay was 1 day (range 1 to 2 days). Conclusions: The use of the Pfannenstiel incision for laparoscopic nephrectomy seems to be feasible even when using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic nephrectomy.

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Transumbilical laparoscopic urological surgery: are special devices strictly necessary?

Cited by 16 publications

References 33 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

Single-port laparoscopic surgery in gynecology—current status

Laparoendoscopic pfannenstiel nephrectomy using conventional laparoscopic instruments - preliminary experience

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