Transumbilical Single-Port Surgery: Evolution and Current Status

• Published in: European urology Vol. 54; no. 5; pp. 1020 - 1030
• Main Authors: Canes, David, Desai, Mihir M., Aron, Monish, Haber, Georges-Pascal, Goel, Raj K., Stein, Robert J., Kaouk, Jihad H., Gill, Inderbir S.
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.11.2008
• Subjects: Animals; Equipment Design; Gynecologic Surgical Procedures - methods; Humans; Laparoscopes - trends; Laparoscopy; Laparoscopy - methods; Laparoscopy - trends; Single port; Transumbilical; Umbilicus; Urologic Surgical Procedures - methods; Urology; Transumbilical; Single port; NOTES; Laparoscopy
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2008.07.009

Single-port transumbilical laparoscopy, also known as embryonic natural orifice transumbilical endoscopic surgery (E-NOTES), has emerged as an attempt to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. Within a short span, several clinical reports have emerged in the urologic literature. As this field is poised to move forward, a complete understanding of its evolution and current status is timely. To summarize and review the history of E-NOTES across surgical disciplines. This review emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes. Specific urological and nonurological applications of single-port surgery to date are summarized. Using the National Library of Medicine database, the English-language literature was reviewed for the past 40 yr. Keyword searches included: scarless, scar free, single port/trocar/incision, intraumbilical, and transumbilical. Within the bibliography of selected references, additional sources were retrieved. The gynecologic and general surgical literature includes approximately 19 papers fulfilling the search criteria, encompassing extirpative procedures only. The urologic literature contains eight published reports of single-trocar transumbilical procedures. These reports are summarized in a chronological manner and grouped by subject. No prospective studies comparing outcomes to standard laparoscopy have been reported. Technical feasibility has been demonstrated for a broad range of extirpative and reconstructive procedures on the upper and lower urinary tracts, including simple and radical nephrectomy, donor nephrectomy, renal cryotherapy, pyeloplasty, ileal ureteral replacement, sacrocolpopexy, and varicocelectomy. E-NOTES has made its initial forays into laparoscopic surgery. Ongoing refinement in technique and instrumentation is likely to expand its future role. Transumbilical single-port laparoscopy attempts to further minimize surgical morbidity. Case reports and small series using this technique originated in the gynecologic and general surgical literature. Urologists using bent or articulating instruments have recently accomplished a wide range of extirpative and reconstructive procedures.