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Natural orifice transluminal endoscopic surgery (NOTES) generated a huge hope among surgeons because it promised scarless surgery and eventually less pain and surgical stress. However, serious limitations regarding reliable visceral closing methods remain unsolved. This article provides an update in development and future applications of transvesical access in the field of surgery.
Natural orifice transluminal endoscopic surgery (NOTES) is one of the most exciting concepts that has emerged recently in the surgical field. All accesses to the abdominal cavity in the porcine model using natural orifices, e.g. transgastric, transvesical, transcolonic and transvaginal, have been described and explored. The experimental feasibility of all procedures by NOTES was successfully demonstrated in the porcine model using different types of natural orifices. However, few translations to the human have been made. NOTES is in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. This paper is an update on the experimental foundation for NOTES and hybrid NOTES and examines the opportunities presented by this new surgical vision.
Arch Esp Urol. 2006 Nov;59(9):893-7. [Transperitoneal laparoscopic adrenalectomy: initial experience] [Article in Spanish] Palacios A, Lima E, Massó P, Versos R, Autorino R, Ramos M, Soares J, Marcelo F. Servicio de Urología, Hospital Geral de Santo António, Porto, Portugal. aphmmx5@hotmail.com Abstract OBJECTIVES: Since the first published report in 1992, laparoscopic adrenalectomy has been widespread and it is now accepted as the standard treatment option in most of benign diseases of the adrenal gland. Aim of the present study is to describe our initial experience with laparoscopic adrenalectomy. METHODS: Between May 2001 and December 2005, 15 patients were submitted to laparoscopic adrenalectomy for benign diseases of the adrenal gland. We analyzed patients characteristics (sex, age, initial diagnosis), operative and periopera...
Urology. 2007 Jan;69(1):27-31; discussion 31-3. Emergency ureteroscopic management of ureteral stones: why not? Osorio L, Lima E, Soares J, Autorino R, Versos R, Lhamas A, Marcelo F. Department of Urology, Santo Antonio General Hospital, Oporto, Portugal. luis_osorio@netcabo.pt Abstract OBJECTIVES: To describe a single-center experience in the emergency ureteroscopic management of ureteral stones. METHODS: We retrospectively considered the data from 144 patients (mean age 49.6 years, range 23 to 82) who had had obstructive ureteral stones and had undergone emergency ureteroscopy with stone retrieval. Intracorporeal pneumatic lithotripsy was performed when necessary. At the end of the procedure, a ureteral catheter was systematically left in place in 100 patients (69.4%) and removed within 24 hours. In the remaining 44 patients, a d...
OBJECTIVE: To assess the feasibility of pure natural orifice transluminal endoscopic surgery (NOTES) transvesical venous ligation mimicking bilateral varicocelectomy in an animal model. MATERIALS AND METHODS: Transvesical NOTES bilateral venous ligation was performed in 6 female pigs by considering lower epigastric vessels as a model for gonadal vessels. Under flexible cystoscopic guidance, a cystotomy was created on the anterior bladder. The flexible cystoscope was introduced through the over tube, and the lower epigastric vessels were visualized in retroflexion. Thulium laser was used to cut and coagulate the vessels. A bladder catheter was left in place for 4 days in all animals and they were sacrificed 15 days after the procedure. RESULTS: The procedure was successfully carried out in all animals without intraoperative complication...
Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been successfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques t...
Evidence relating to the perception and view of patients and physicians on natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) was scrutinized. A comprehensive literature search was performed through PubMed. A total of 18 studies were included in the analysis. Patients demonstrated interest in scarless surgery, with a preference for LESS over NOTES. Safety and efficacy remain the key factors in the decision-making process of patients. With more information about the safety and reproducibility of LESS and NOTES, and with improved educational efforts, patients and physicians alike may feel more comfortable in widespread application of scarless surgery.
Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Until now, the transvaginal approach has been the only method of removing larger specimens from the abdominal cavity using natural orifice transluminal endoscopic surgery. There has been no means of extracting larger specimens in men and the means are restricted even in women, particularly in young women. The present study shows that the difficulty of large specimen retrieval can be overcome, irrespective of the diameter of the chosen port, through natural orifices using morcellation. OBJECTIVE: To show, in a porcine model, the feasibility of a complete transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney extraction after morcellation through the same port. MATERIALS AND METHODS: Tr...
BACKGROUND: Transvesical port refers to the method of accessing the abdominal cavity through a natural orifice (i.e., urethra) under endoscopic visualization. Since its introduction in 2006, various reports have been published describing different surgical interventions using a rigid ureteroscope in a porcine model. The aim of this study was to test the access and feasibility of peritoneoscopy by using a rigid ureteroscope in a human male cadaver. METHODS: Two adult male cadavers were used to perform the procedures. A rigid ureteroscope was used for the creation of transvesical access into the peritoneal cavity. Peritoneoscopy, liver biopsy, and identification and manipulation of the ileocecal appendix were performed. RESULTS: Transvesical access into the peritoneal cavity was quickly established. The rigid ureteroscope easily allowed ...
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