BERKELEY, CA (UroToday.com) - There is increasing interest for a new surgical technique called Natural Orifice Translumenal Endoscopic Surgery (NOTES) and this report suggests an alternate approach that may be more efficacious. These laparoscopic surgeons are using one skin incision at the umbilicus to place a 10 mm and two 5mm ports to perform transperitoneal nephrectomy. They admit that this is associated with awkward internal and external collision of the instruments, even with specially designed articulating laparoscopic instruments. However, despite these limitations they were able to perform 3 clinical laparoscopic nephrectomies in reasonable operative time (range 90-160 minutes, mean 133 mins.) with no complications. The nephrectomy for tumor still required a 4.5 cm incision for intact removal of the specimen. The question remains whether this is any better for the patient than three or four, 5 to 10 mm, incisions.

This is interesting new technology still in its developmental stage, but may offer similar results as (NOTES) for urologic diseases, but without the concern of transgression of the natural anatomic barrier of the vagina or the stomach wall. Considerably more development of instruments and technique will be necessary before this approach is widely accepted for laparoscopic extirpative procedures and most assuredly for the more demanding laparoscopic reconstructive procedures. Ultimately clinical studies will be necessary to compare patient morbidity and recovery for pure laparoscopic, keyhole and NOTES approaches before either of these alternatives will be widely adopted.

JD Raman, K Bensalah, A Bagrodia, JM Stern, JA Cadeddu

Urology. 2007 Dec;70(6):1039-42

PubMed Abstract
PMID: 18158008

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Written by Elspeth M. McDougall, MD, a Contributing Editor with UroToday.

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