Abstract
Purpose
To review the minimal-invasive development of surgical technique in urology focusing on nomenclature, history and outcomes of Laparo-Endoscopic Single-site Surgery (LESS), Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Computer-Assisted Surgery (CAS).
Methods
A comprehensive literature search was conducted in order to find article related to LESS, NOTES and CAS in urology. The most relevant papers over the last 10 years were selected in base to the experience from the panel of experts, journal, authorship and/or content.
Results
Seven hundred and fifty manuscripts were found. Papers on LESS describe feasibility/safety in most of the procedures with a clinical experience of more than 300 cases and five compared results to standard laparoscopy without showing significant differences. NOTES accesses have been proved their feasibility/safety in experimental study. In human, the only procedures performed are on kidney and through a hybrid-Transvaginal route. New robots overcome the main drawbacks of the DaVinci® platform. The use of CAS is increasing its popularity in urology.
Conclusions
LESS has been applied in clinical practice, but only ongoing technical and instrumental refinement will define its future role and overall benefit. The transition to a clinical application of NOTES seems at present only possible with multiple NOTES access and transvaginal access. Robot and Soft Tissue Navigation appear to be important to improve surgical skills. We are already witness to the advantages offered by the former even if costs need to be redefined based on pending long-term results. The latter will probably upgrade the quality of surgery in a near future.
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Abbreviations
- LESS:
-
Laparo-Endoscopic Single-site Surgery
- NOTES™:
-
Natural orifice transluminal endoscopic surgery
- CAS:
-
Computer-Assisted Surgery
- IGS:
-
Image-Guided System
- AR:
-
Augmented reality
- 3D:
-
Three dimensional
- US:
-
Ultrasound
- TURP:
-
Transurethral resection of prostate
- DoF:
-
Degree of freedom
- RP:
-
Radical prostatectomy
- RALP:
-
Robot-Assisted Radical Prostatectomy
- CT:
-
Computed tomography
- MRI:
-
Magnetic resonance imaging
- FDA:
-
Food and drug administration
- DoF:
-
Degrees of freedom
- RALP:
-
Robot-assisted laparoscopic prostatectomy
- VR:
-
Virtual reality
- AR:
-
Augmented reality
- STN:
-
Soft tissue navigation
- RRP:
-
Radical retropubic prostatectomy
- TRUS:
-
Ultrasonography trans-rectal ultrasonography
References
Autorino R, Stein RJ, Lima E, Damiano R, Khanna R, Haber GP, White MA, Kaouk JH (2010) Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery. Int J Urol 17:410–431. doi:10.1111/j.1442-2042.2010.02497.x
Teber D, Baumhauer M, Guvenc EO, Rassweiler J (2009) Robotic and imaging in urological surgery. Curr Opin Urol 19:108–113. doi:10.1097/MOU.0b013e32831a4776
Box G, Averch T, Cadeddu J et al (2008) Nomenclature of natural orifice translumenal endoscopic surgery (NOTESTM) and laparoendoscopic single-site surgery (LESS) procedures in urology. J Endourol 22:2575–2581. doi:10.1089/end.2008.0471
Raman JD, Bagrodia A, Cadeddu JA (2009) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: A comparison of peri-operative outcomes and short-term measures of convalescence. Eur Urol 55:1198–1204. doi:10.1016/j.eururo.2008.08.019
Desai MM, Berger AK, Brandina R et al (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74:805–812. doi:10.1016/j.urology.2009.02.083
White WM, Haber GP, Goel RK, Crouzet S, Stein RJ, Kaouk JH (2009) Single-port urological surgery: single-center experience with the first 100 cases. Urology 74:801–804. doi:10.1016/j.urology.2009.04.030
Raybourn JH III, Rane A, Sundaram CP (2009) Laparoendoscopic single-site surgery for nephrectomy as a feasible alternative to traditional laparoscopy. Urology 75:100–103. doi:10.1016/j.urology.2009.05.028
Stolzenburg JU, Kallidonis P, Hellawell G et al (2009) Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur Urol 56:644–650. doi:10.1016/j.eururo.2009.06.022
Canes D, Berger A, Aron M et al (2009) Laparo-Endoscopic Single Site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 57:95–101. doi:0.1016/j.eururo.2009.07.023
Tracy CR, Raman JD, Bagrodia A, Cadeddu JA (2009) Perioperative outcomes in patients undergoing conventional laparoscopic versus laparoendoscopic single-site pyeloplasty. Urology 74:1029–1034. doi:10.1016/j.urology.2009.04.089
Noguera RJ, Astigueta JC, Carmona O et al (2009) Laparoscopic augmentation enterocystoplasty through a single trocar. Urology 73:1371–1374. doi:10.1016/j.urology.2009.01.019
Jeong BC, Park YH, Han DH, Kim HH (2009) Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study. J Endourol 23:1957–1960. doi:10.1089=end.2009.0404
Kaouk JH, Goel RK (2009) Single-port laparoscopic and robotic partial nephrectomy. Eur Urol 55:1169–1170. doi:10.1016/j.eururo.2008.12.029
Breda G, Silvestre P, Giunta A et al (1993) Laparoscopic nephrectomy with vaginal delivery of the intact kidney. Eur Urol 24:116–117
Gettman MT, Lotan Y, Napper CA et al (2002) Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 59:446–450
Kalloo AN, Singh VK, Jagannath SB et al (2004) Fexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117
Lima E, Rolanda C, Pego JM, Henrique Coelho T, Silva D, Carvalho JL, Correia-Pinto J (2006) Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery. J Urol 176:802–805. doi:10.1016/j.juro.2006.03.075
Fong DG, Pai RD, Thompson CC (2007) Transcolonic endoscopic abdominal exploration: a NOTES survival study in porcine model. Gastrointest Endosc 65:312–318. doi:10.1016/j.gie.2006.08.005
Boylu U, Oommen M, Thomas R, Lee BR (2009) Transumbilical single-port laparoscopic partial nephrectomy in a pig model. BJU Int. doi:10.1111/j.1464-410X.2009.08916.x
Sawyer MD, Cherullo EE, Elmunzer BJ, Schomisch S, Ponsky LE (2009) Pure natural orifice translumental endoscopic surgery partial cystectomy: intravesical transurethral and extravesical transgastric techniques in a porcine model. Urology 74:1049–1053
Clayman RV, Box GN, Abraham JB et al (2007) Rapid communication: transvaginal single-port NOTES nephrectomy: initial laboratory experience. J Endourol 21:640–644
Pai RD, Fong DG, Bungda ME et al (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in porcine model (with video). Gastrointest Endosc 64:428–434
Lima E, Rolanda C, Correia-Pinto J (2009) NOTES performed using multiple ports of entry: current experience and potential implications for urologic applications. J Endourol 23:759–764. doi:10.1089=end.2008.0026
Lima E, Rolanda C, Pego JM et al (2007) Third-generation nephrectomy by natural orifice transluminal endoscopic surgery. J Urol 178:2648–2654. doi:10.1016/j.juro.2007.07.117
Crouzet S, Haber GP, Kamoi K et al (2008) Natural orifice translumental endoscopic surgery (NOTES) renal cryoablation in a porcine model. BJU Int 102:1715–1718
Gettman MT, Blute ML (2007) Transvesical peritoneoscopy: initial clinical evaluation of the bladder as a portal for natural orifice translumenal endoscopic surgery. Mayo Clin Proc 82:843–845
Branco AW, Branco Filho AJ, Kondo W et al (2008) Hybrid transvaginal nephrectomy. Eur Urol 53:1290–1294
Alcaraz A, Peri L, Molina A et al (2009) Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy. Eur Urol 57:233–237. doi:10.1016/j.eururo.2009.09.025
Sotelo R, de Andrade R, Fernandez G et al (2010) NOTES hybrid transvaginal radical nephrectomy for tumor: stepwise progression toward a first successful clinical case. Eur Urol 57:138–144. doi:10.1016/j.eururo.2009.04.031
Haber GP, Crouzet S, Kamoi K, Berger A, Aron M, Goel R, Canes D, Desai M, Gill AI, Kaouk JH (2008) Robotic NOTES (natural orifice transluminal endoscopic surgery) in reconstructive urology: initial laboratory experience. Urology 71:996–1000. doi:10.1016/j.urology.2008.03.023
Joseph JV, Oleynikov D, Renteschler M, Dumpert J, Patel HRH (2008) Microrobot assisted laparoscopic urological surgery in a canine model. J Urol 180:2202–2205. doi:10.1016/j.juro.2008.07.016
Leheman AC, Dumpert J, Wood NA et al (2009) Natural orifice cholecistectomy using a miniature robot. Surg Endosc 23:260–266. doi:10.1007/s00464-008-0195-3
Aron M, Haber GP, Desai MM, Gill IS (2007) Flexible robotics: a new paradigm. Current Op Urol 17:151–155
Ukimura O, Gill IS (2008) Imaging-assisted endoscopic surgery: cleveland clinic experience. J Endourol 22:803–810; review. doi: 10.1089/end.2007.9823
Baumhauer M, Feuerstein M, Meinzer HP et al (2008) Navigation in endoscopic soft tissue surgery: perspectives and limitations. J Endourol 22:751–766. doi:10.1089/end.2007.9827
Teber D, Guven S, Simpfendörfer T, Baumhauer M, Güven EO, Yencilek F, Gözen AS, Rassweiler J (2009) Augmented reality: a new tool to improve surgical accuracy during laparoscopic partial nephrectomy? Preliminary in vitro and in vivo results. Eur Urol Aug 56:332–338. doi:10.1016/j.eururo.2009.05.017
Su LM, Vagvolgyi BP, Agarwal R, Reiley CE, Taylor RH, Hager GD (2009) Augmented reality during robot-assisted laparoscopic partial nephrectomy: toward real-time 3D-CT to stereoscopic video registration. Urology 73:896–900. doi:10.1016/j.urology.2008.11.040
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Micali, S., Pini, G., Teber, D. et al. New trends in minimally invasive urological surgery. What is beyond the robot?. World J Urol 31, 505–513 (2013). https://doi.org/10.1007/s00345-010-0588-5
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DOI: https://doi.org/10.1007/s00345-010-0588-5