History of NOTES and LESS


Year

Procedure

Approach

References

2006

Appendectomy

Transgastric

Rao & Reddy [13]

2007

Cholecystectomy

Transvaginal

Zorron et al. [14]

2008

Colectomy

Transvaginal

Lacy et al. [15]

2008

Peritoneoscopy

Transgastric

Hazey et al. [16]

2008

Peritoneoscopy

Transvaginal

Zorron et al. [17]

2008

Appendectomy

Transvaginal

Palanivelu et al. [18]

2008

Gastrectomy

Transvaginal

Ramos et al. [19]

2009

Cholecystectomy

Transgastric

Auyang et al. [20]

2009

Nephrectomy

Transvaginal

Kaouk et al. [12]

2009

Splenectomy

Transvaginal

Targarona et al. [21]

2010

Gastric banding

Transvaginal

Michalik et al. [22]

2010

Incisional hernia repair

Transvaginal

Jacobsen et al. [23]

2011

Gastric mass resection

Transgastric

Willingham et al. [24]



One notable milestone in the inception and development of NOTES was the recognition that the adaptation of this novel surgical approach must be performed in a safe, structured and carefully monitored fashion. A summit was held in 2005 with members from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the American Society for Gastrointestinal Endoscopy (ASGE) collaborating to determine the appropriate pathway for the safe and responsible development and evaluation of NOTES. This culminated in the publication of a white paper which set out the challenges and goals for NOTES, as well as a roadmap for addressing them [25]. An organization called the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) was formed to lead this effort, and to manage a registry of trials and human procedures in the field. A second white paper was published in 2011, reporting on progress made [26]. The uptake of NOTES has remained largely experimental, and numerous challenges continue to prevent widespread adoption of this surgical approach. It remains an exciting but challenging area for future development and progress.



LESS


While modern single-site laparoscopy is considered relatively new, the origins of laparoscopy were in fact in single-site procedures. In 1961 Platteborse described access to the abdominal cavity with a 12 mm trocar and a working channel [27], allowing biopsies of the liver and gall bladder. Around the same time Steptoe began gynaecological laparoscopic procedures [28], which would culminate in his collaboration with Edwards and the birth of in-vitro fertilisation. Using his technique of access, a series of 25 laparoscopic sterilisations was subsequently carried out at Johns Hopkins Hospital by Wheeless in 1969 [29].

As interest in laparoscopy grew it became apparent that multiple instruments and ports would be necessary to achieve the required retraction and triangulation in more complex procedures, as well as to reduce the potential for instrument clashes. The progression to multi-port laparoscopy enabled the technique to emerge as not only a viable alternative to traditional methods of open surgery, but eventually as the preferred surgical approach in many procedures today. There was still, however, interest in single-port surgery by some pioneers. Notably, the American gynaecologist Pelosi, who performed the first major extirpative single-site procedure in 1991—a hysterectomy with bilateral salpingo-oophrectomy via a single transumbilical port [30]. His group subsequently reported a supracervical hysterectomy and the earliest series of single-port appendectomies [31, 32]. In 1997 Navarra published his report of a single-port laparoscopic cholecystectomy [33]. Over the next decade, the indication and complexity of reported cases increased. Emergency procedures such as salpingectomy for ectopic pregnancy were carried out and described as “feasible and safe” by Ghezzi et al. in 2005 [34]. A series of paediatric procedures was reported by Cobellis et al. in 2006, where a single 10 mm transumbilical trocar was used to identify a Meckel’s diverticulum and bring it to the skin, where the diverticulum was excised [35].

Single-port urological procedures were first described in the early twenty-first century. Hirano et al. reported a series of single-port adrenalectomies in 2005 [36]. These were performed using a large (4 cm) port inserted into the retroperitoneum, with no gas insufflation. However, significant complications were reported, including fulminant hepatitis, pulmonary embolism and death. The first successful laparo-endoscopic single-site urological procedure (a simple nephrectomy in a 36 year old man) was presented by Rane et al. at the World Congress of Endourology in 2007 [37]. A multichannel port (the R-port, Advanced Surgical Concepts, Wicklow, Ireland) was used via a single flank incision to insert a 5 mm telescope, two further 5 mm instruments and a 10 mm clip applier. The same group subsequently reported successful ureterolithotomy, orchidopexy and orchiectomy [37]. Raman et al. reported a series of nephrectomies in 2007, utilising multiple trocars and articulating instruments via a single umbilical incision [38]. These were performed for both benign as well as malignant disease. Radical nephrectomies as well as pyeloplasties were reported by Desai et al. in 2008, this time using custom-designed curved instruments and the R-port; a supplementary 2 mm needle port was also used [39].

The range and complexity of single-port urological procedures grew rapidly. Kaouk et al. reported laparoscopic renal cryoablation, wedge renal biopsy and sacrocolpopexy in 2008, and further experiences with LESS reconstructive procedures were reported including dismembered pyeloplasty, ureteral reimplantation with psoas hitch, ileal ureter construction and urteroneocystostomy [40, 41]. A series of live donor nephrectomies via a LESS approach was reported in 2008 by Gill et al., with no complications and excellent graft outcome [42]. This was followed by highly complex extirpative procedures successfully performed via a LESS approach, including radical prostatectomy and radical cystectomy with pelvic lymph node dissection [43, 44] (Table 21.2).


Table 21.2
Highlights of Laparoendoscopic Single-Site Surgery (LESS) procedures
















































































































Year

Procedure

Approach

References

1969

Tubal ligation

Single transumbilical trocar

Wheeless [29]

1991

Hysterectomy with bilateralsalpingo-oophorectomy

Single transumbilical trocar

Pelosi et al. [30]

1992

Supracervical hysterectomy with bilateral salpingo-oophorectomy

Single transumbilical trocar

Pelosi et al. [31]

1992

Appendectomy

Single transumbilical trocar

Pelosi et al. [32]

1997

Cholecystectomy

Single transumbilical trocar

Navarra et al. [33]

2001

Ovarian cystectomy

Single transumbilical trocar

Kosumi et al. [45]

2005

Salpingectomy for ectopic pregnancy

Single transumbilical trocar

Ghezzi et al. [34]

2005

Retroperitoneal adrenalectomy

Single retroperitoneal port. Noinsufflation used

Hirano et al. [36]

2006

Meckel’s diverticulectomy

Single transumbilical trocar

Cobellis et al. [35]

2007

Simple nephrectomy, radical nephrectomy

Single transumbilical incision, multiple ports

Raman et al. [38]

2007

Simple nephrectomy

Single port through a flank incision

Rane et al. [37]

2008

Orchidectomy, orchidopexy, ureterolithotomy

Transumbilical R-port

Rane et al. [37]

2008

Simple nephrectomy

Single transumbilical port

Desai et al. [39]

2008

Pyeloplasty

Transumbilical port and 2 mm needle port

Desai et al. [39]

2008

Renal cryotherapy, radical nephrectomy, wedgekidney biopsy, sacrocolpopexy

Single transumbilical port

Kaouk et al. [40]

2008

Live donor nephrectomy

Transumbilical port and 2 mm needle port

Gill et al. [42]

2008

Paediatric varicocelectomy

Single transumbilical trocar

Kaouk et al. [46]

2008

Radical prostatectomy

Single transumbilical port

Kaouk et al. [43]

2008

Transvesical simple prostatectomy

Single port introduced percutaneously through the bladder

Desai et al. [47]

2008

Transvesical robotic radical prostatectomy (cadaveric)

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Jan 29, 2018 | Posted by in UROLOGY | Comments Off on History of NOTES and LESS

Full access? Get Clinical Tree

Get Clinical Tree app for offline access