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
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DOI：
10.1016/j.eururo.2010.08.030
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发表时间：
2011-01-01
期刊：
影响因子：
23.4
通讯作者：
Kaouk, Jihad H.
中科院分区：
文献类型：
--
作者：
Autorino, Riccardo;Cadeddu, Jeffrey A.;Kaouk, Jihad H.
内容：自然腔道经腔内镜手术（NOTES）和腹腔镜单孔手术（LESS）的发展使外科医生能够进行无瘢痕手术，使患者受益。目的：总结和批判性分析LESS和NOTES在泌尿外科的现状和未来前景的现有证据。证据获取：于2010年6月使用Medline数据库进行了一次全面的电子文献检索，以识别与NOTES和LESS在泌尿学中相关的所有出版物。在泌尿外科，NOTES已通过经胃、经阴道、经结肠和经膀胱途径实验性完成。初步临床经验表明，NOTES泌尿外科手术使用目前可用的仪器确实是可能的。然而，由于仪器的不成熟，早期的情况下，需要很高的技术精湛。LESS可以在各种泌尿外科环境中安全有效地进行。随着临床经验的增加，预计将记录扩大的适应症，并提高手术的有效性。到目前为止，所有可用研究的证据质量仍然很低，大多数是来自选定中心的小型病例系列或病例对照研究。因此，LESS的唯一客观受益仍然是改善的美容效果。前瞻性随机研究在很大程度上等待确定哪些LESS程序将被建立，哪些不太可能经得起时间的考验。技术进步有望最大限度地减少无瘢痕手术的技术挑战性。在这方面，机器人技术很可能会推动一个重大的范式转变，在发展的LESS和NOTES.Conclusions：NOTES仍然是一种研究方法，在泌尿外科。LESS已被证明可立即应用于临床领域，在经验丰富的腹腔镜外科医生手中安全可行。器械的发展和机器人技术的应用有望确定这些技术在微创泌尿外科手术中的实际作用。(C)2010年欧洲泌尿外科协会。Elsevier B.V.出版，保留所有权利。
Context: 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 case-control 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. (C) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.