Department of Urology, University of Patras Medical School, Rion, 26 500 Patras, Greece.
World J Urol. 2012 Oct;30(5):581-7. doi: 10.1007/s00345-011-0766-0. Epub 2011 Oct 21.
Laparoendoscopic single-site surgery (LESS) has emerged in the recent years as an alternative approach to conventional laparoscopic surgery which is accompanied by additional advantages over laparoscopy. In this work we attempt to review the current literature and to investigate the possible combination of LESS to other currently available approaches such as natural orifice transluminal endoscopic surgery (NOTES), needlescopic and robotic laparoscopic surgery.
Extensive literature search on the topics of LESS, hybrid and pure NOTES, Needlescopic-assisted LESS and "Robot-assisted LESS" took place. Additionally, the accumulated experience from 118 LESSs performed in our departments is presented in an attempt to provide evidence regarding the mix of technique in LESS in urology.
The challenging nature of LESS limits the broader application and acceptance. Expanding experience in single-site surgery has currently provided tools such as transvaginal access, needlescopic instruments and robot assistance that can aid LESS and enhance its efficiency without compromising any of its advantages. A mix of these techniques with LESS could ease the stiff learning curve of the second and benefit not only its performance but also the adaptation of LESS as a standard practice.
Pure LESS although feasible, remains a technical challenge for the surgeon, preventing the widespread application of the technique. The goal of urologists on LESS surgery should not be the purity of LESS approach, but the superiority against already established techniques. A mix of techniques could be a key for the documentation of the advantages of LESS over conventional laparoscopy.
近年来，经脐单孔腹腔镜手术（LESS）作为一种替代传统腹腔镜手术的方法出现，与腹腔镜相比具有额外的优势。在这项工作中，我们试图回顾当前的文献，并研究将 LESS 与其他当前可用的方法（如自然腔道内镜手术（NOTES）、针腔镜辅助 LESS 和机器人辅助 LESS）相结合的可能性。
对 LESS、杂交和纯 NOTES、针腔镜辅助 LESS 和“机器人辅助 LESS”等主题进行了广泛的文献检索。此外，还介绍了我们科室 118 例 LESS 经验，试图为泌尿外科 LESS 技术组合提供证据。
LESS 的挑战性限制了其更广泛的应用和接受程度。在单部位手术方面的经验不断增加，目前提供了经阴道入路、针腔镜器械和机器人辅助等工具，可以辅助 LESS 并提高其效率，而不会影响其任何优势。将这些技术与 LESS 结合使用，可以减轻该技术第二阶段的陡峭学习曲线，不仅可以提高其性能，还可以促进 LESS 作为标准实践的适应。
尽管纯 LESS 是可行的，但对外科医生来说仍然是一项技术挑战，阻碍了该技术的广泛应用。泌尿外科医生在 LESS 手术中的目标不应该是 LESS 方法的纯度，而是与已建立的技术相比的优势。技术组合可能是记录 LESS 相对于传统腹腔镜手术优势的关键。
