Minimally invasive surgery in urology: is the winner natural-orifice translumenal endoscopic surgery or laparoendoscopic single-site surgery?

摘要

Two different techniques have emerged that aspire to improve the outcomes of minimally invasive urological surgery, particularly cosmetic results. The first, natural-orifice translumenal endoscopic surgery (NOTES) uses natural orifices such as the mouth, bladder, vagina or rectum to perform diagnostic and therapeutic manoeuvres. The first experimental study using the gastrointestinal tract for NOTES was published in 2004; however, it was not until 2007 that Marescaux et al. [1] described the first cholecystectomy performed by transvaginal NOTES. NOTES is achieved by siting all operative instruments through one transvisceral incision. Unfortunately, this 'inline' placement of instruments generates clashing, suboptimal exposure, and imprecise and/or unreliable tissue handling. Although some of these limitations have been addressed through product development and surgeon ingenuity, there remain significant barriers to its pragmatic application. A degree of unease still exists regarding the prudence of electively incising through one normal hollow organ simply to get to another. NOTES within urology until recently has been limited to experimental animal models and diagnostic procedures in humans. Transvaginal urological applications were first reported by Gettman etal. [2] in 2002, but it was only 7 years later that isolated clinical cases in urology were performed by pioneers who were skilled laparoscopic surgeons. Extirpative and reconstructive procedures have usually required additional transabdominal port placement assistance to facilitate exposure [3].