Granberg Candace F, Gettman Matthew T
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Indian J Urol. 2010 Jul;26(3):385-8. doi: 10.4103/0970-1591.70577.
To describe the evolution of instrumentation and technology for natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) as applied to urologic procedures.
We performed a search of published reports on PubMed and MEDLINE for the search terms NOTES, single-port, single-incision, single-site, natural orifice + surgery, SPA, LESS, incisionless, and scarless from 1990-2009. Studies relevant to this urologic symposium were chosen for detailed review.
Multiple case reports, case series, and review articles relevant to NOTES and LESS utilized for urologic surgery dating from 1991 to 2009 were identified. We were subsequently able to chronicle the technological advances in instrumentation utilized for NOTES, including transvaginal nephrectomy, transvesical NOTES, combination or hybrid NOTES, and robotic-assisted NOTES or R-NOTES. For LESS, we detailed the development of various access ports and operating platforms to facilitate performing urologic procedures through a single-port access site.
Significant progress has been made in developing new, multi-lumenal access ports and articulating or curved instruments to aid in triangulation necessary for certain urologic procedures. Magnetic anchoring guidance systems (MAGS) have further enhanced the approach to LESS, with the potential for future application to NOTES. NOTES and LESS have future implications for the armamentarium of urologic surgeons, although much more research is necessary to further improve instrumentation and overcome the learning curve necessary for new technology.
描述应用于泌尿外科手术的经自然腔道内镜手术（NOTES）和腹腔镜单切口手术（LESS）的器械及技术的发展历程。
我们在PubMed和MEDLINE上搜索了1990年至2009年发表的报告，搜索词为NOTES、单孔、单切口、单部位、自然腔道+手术、SPA、LESS、无切口和无痕。选择与本次泌尿外科研讨会相关的研究进行详细综述。
确定了1991年至2009年期间与用于泌尿外科手术的NOTES和LESS相关的多篇病例报告、病例系列和综述文章。随后，我们能够记录NOTES所用器械的技术进步，包括经阴道肾切除术、经膀胱NOTES、联合或混合NOTES以及机器人辅助NOTES或R-NOTES。对于LESS，我们详细介绍了各种接入端口和操作平台的发展，以利于通过单端口接入部位进行泌尿外科手术。
在开发新的多腔道接入端口和可弯曲器械以辅助某些泌尿外科手术所需的三角定位方面取得了重大进展。磁锚定引导系统（MAGS）进一步改进了LESS的手术方法，未来有可能应用于NOTES。NOTES和LESS对泌尿外科医生的器械装备具有未来意义，尽管还需要更多研究来进一步改进器械并克服新技术所需的学习曲线。
