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经自然腔道内镜技术和单孔腹腔镜技术在结直肠外科手术中的应用 总被引:2,自引:0,他引:2
胡三元 《中华胃肠外科杂志》2012,15(8):770-772
经自然腔道内镜手术(NOTES)和单孔腹腔镜手术(LESS)是当今国际微创外科领域的研究与临床应用热点。NOTES技术尚待进一步的发展.而LESS技术是现阶段最可行的体表“无疤痕”技术。是NOTES技术的过渡阶段。虽然腹腔镜辅助的NOTES结直肠手术和完全的NOTES结直肠手术已经见诸报道.但是该手术目前仍然主要处于动物试验阶段。LESS技术在结直肠手术中的应用已经较为广泛.其可行性已经为较多的文献资料证实.而其是否符合肿瘤根治原则尚需进一步的研究确定。 相似文献
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Riccardo Autorino Jeffrey A. Cadeddu Mihir M. Desai Matthew Gettman Inderbir S. Gill Louis R. Kavoussi Estevão Lima Francesco Montorsi Lee Richstone Jens U. Stolzenburg Jihad H. Kaouk 《European urology》2011
Context
Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery.Objective
To summarize and critically analyze the available evidence on the current status and future perspectives of LESS and NOTES in urology.Evidence acquisition
A comprehensive electronic literature search was conducted in June 2010 using the Medline database to identify all publications relating to NOTES and LESS in urology.Evidence synthesis
In urology, NOTES has been completed experimentally via transgastric, transvaginal, transcolonic, and transvesical routes. Initial clinical experience has shown that NOTES urologic surgery using currently available instruments is indeed possible. Nevertheless, because of the immaturity of the instrumentation, early cases have demanded high technical virtuosity. LESS can safely and effectively be performed in a variety of urologic settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low, mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains the improved cosmetic outcome. Prospective, randomized studies are largely awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technology advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics is likely to drive a major paradigm shift in the development of LESS and NOTES.Conclusions
NOTES is still an investigational approach in urology. LESS has proven to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons. Development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery. 相似文献4.
We reviewed the preliminary advances in laparo‐endoscopic single‐site surgery (LESS) as applied to renal surgery, and analyzed current publications based on animal models and human patients. We searched published reports in major urological meeting abstracts, Embase and Medline (1966 to 25 August 2008), with no language restrictions. Keyword searches included: ‘scarless’, ‘scar free’, ‘single port/trocar/incision’, ‘intraumbilical’, and ‘transumbilical’, ‘natural orifice transluminal endoscopic surgery’ (NOTES), ‘SILS’, ‘OPUS’ and ‘LESS’. The lessons learnt from the studies using the porcine model are that further advances in instrumentation are essential to achieve optimum results, and that testing survival in animals is also necessary to further expand the NOTES and LESS techniques. Further advances in instrument technology together with increasing experience in NOTES and LESS approaches have driven the transition from porcine models to human patients. In the latter, studies show that the techniques are feasible provided that both optimal surgical technical expertise with advanced skills, and optimal instrumentation, are available. The next step towards minimal access/minimally invasive urological surgery is NOTES and LESS. It is inevitable that LESS will be extended to involve more complex and technically demanding procedures such as laparoscopic radical prostatectomy and partial nephrectomy. 相似文献
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Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. LaparoEndoscopic Single Site (LESS) surgery potentially takes this further. Following the first human urological LESS report in 2007, numerous case series have emerged, as well as comparative studies comparing LESS with standard laparoscopy. Technological developments in instrumentation, access and optics devices are overcoming some of the challenges that are raised when operating through a single site. Further advances in the technique have included the incorporation of robotics (R-LESS), which exploit the ergonomic benefits of ex vivo robotic platforms in an attempt to further improve the implementation of LESS procedures. In the future, urologists may be able to benefit from in vivo micro-robots that will allow the manipulation of tissue from internal repositionable platforms. The use of magnetic anchoring and guidance systems (MAGS) might allow the external manoeuvring of intra-corporeal instruments to reduce clashing and facilitate triangulation. However, the final promise in minimally invasive surgery is natural orifice transluminal endoscopic surgery (NOTES), with its scarless technique. It remains to be seen whether NOTES, LESS, or any of these future developments will prove their clinical utility over standard laparoscopic methods. 相似文献
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J.M. García-Mediero P.M. Cabrera F. Cáceres E. Mateo A. García-Tello J.C. Angulo 《Actas urologicas espa?olas》2013,37(2):106-113
ContextLaparoscopic surgery in urology is considered to be an important advance, although it is not exempt from some morbidity associated to the use of multiple trocars and specifically to the extraction of the specimen. In order to decrease this morbidity and improve esthetics, other techniques are being developed, such as natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). It is aimed to review the current status of laparoendoscopic single site surgery in urology.Acquisition of evidenceA nonsystematic review has been carried out by means of the bibliographic search using the terms LESS and Urology from 2007 to 2012. The current LESS experience in urology is described, and its principal indications and the different single site devices and instruments available on the market are described.Synthesis of evidenceLESS surgery arose as one more step in the constant evolution of minimally invasive surgery in an attempt to improve esthetics, reduce surgical trauma and decrease pain and the post-operative complications associated to the conventional laparoscopy with multiple trocars. Since it was first described in 2007, the experience has been increasing exponentially and the LESS technique, whether assisted or not by robot, is becoming consolidated for a large spectrum of urological indications (both in oncological and reconstructive surgery) on a much greater scale than the NOTES technique. Even though most of the existing data are not randomized and very rarely comparative, with the selection bias that this represents, it seems clear that the esthetic benefit and analgesic control associated to the LESS surgery is real and reproducible. The complications associated to it are greater in cases of major oncology surgery and are due more to the technique itself then to the approach.ConclusionsAlthough the real benefit of the LESS surgery in urology cannot be appropriately quantified, the cosmetic improvement, less pain and greater patient satisfaction with their wound are clear. Appropriate training in this type of procedures in centers having large volumes and the continuous technical improvements in the instrumental development by the biomedical industry has resulted in the fact that the transumbilical LESS technique in urology has been born to stay. 相似文献
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Jihad H. Kaouk Georges-Pascal Haber Raj K. Goel Sebastien Crouzet Stacy Brethauer Farzeen Firoozi Howard B. Goldman Wesley M. White 《European urology》2010
Natural orifice translumenal endoscopic surgery (NOTES) within urology has largely been limited to experimental animal studies and diagnostic procedures in humans. Attempts to complete a pure NOTES transvaginal nephrectomy have thus far been unsuccessful. We report the first clinical experience with pure NOTES transvaginal nephrectomy. 相似文献
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单孔腔镜技术发展带给我们的思考 总被引:4,自引:0,他引:4
经自然孔道内镜外科(natural orifice transluminal endoscopic surgery, NOTES)经过近10年的研究,已经由一个理想中的概念走向初步的临床应用。由于其尚存在诸多较难克服的技术瓶颈,现阶段仍无法广泛开展。经脐单孔腔镜手术是目前最现实可行的“无瘢痕”技术。该技术近年来在国内外进展迅速,但是仍然存在许多亟待改进的方面,包括操作技巧的进步、器械设备的研发和手术观念的提高。该技术的临床应用和适应证的拓展将为NOTES手术提供有益的技术准备,若与内镜相结合,则可发挥各自的优势,使病人得到更为安全、有效、微创的治疗。由此可见,腔镜医生的培养需要辅以内镜技术的培训,这样才能造就技术全面的微创外科医生。 相似文献
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Scarless surgery is the Holy Grail of surgery and the very raison d'etre of Minimal Access Surgery was the reduction of scars and thereby pain and suffering of the patients. The work of Muhe and Mouret in the late 80s, paved the way for mainstream laparoscopic procedures and it rapidly became the method of choice for many intra-abdominal procedures. Single-incision laparoscopic surgery is a very exciting new modality in the field of minimal access surgery which works for further reducing the scars of standard laparoscopy and towards scarless surgery. Natural orifice translumenal endoscopic surgery (NOTES) was developed for scarless surgery, but did not gain popularity due to a variety of reasons. NOTES stands for natural orifice translumenal endoscopic surgery, a term coined by a consortium in 2005. NOTES remains a research technique with only a few clinical cases having been reported. The lack of success of NOTES seems to have spurred on the interest in single-incision laparoscopy as an eminently doable technique in the present with minimum visible scarring, rendering a 'scarless' effect. Laparo-endoscopic single-site surgery (LESS) is, a term coined by a multidisciplinary consortium in 2008 for single-incision laparoscopic surgery. These are complementary technologies with similar difficulties of access, lack of triangulation and inadequate instrumentation as of date. LESS seems to offer an advantage to surgeons with its familiar field of view and instruments similar to those used in conventional laparoscopy. LESS remains a evolving special technique used successfully in many a centre, but with a significant way to go before it becomes mainstream. It currently stands between standard laparoscopy and NOTES in the armamentarium of minimal access surgery. This article outlines the development of LESS giving an overview of all the techniques and devices available and likely to be available in the future. 相似文献
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Abhay Rane Shwan Ahmed Sashi S. Kommu Christopher J. Anderson Peter D. Rimington 《BJU international》2009,104(2):230-233
OBJECTIVE
To present the UK experience to date with laparoendoscopic single‐site surgery (LESS) simple nephrectomy.PATIENTS AND METHODS
Five female patients underwent LESS nephrectomy; three procedures were carried out with the umbilicus as the port of entry (U‐LESS).RESULTS
All cases were completed uneventfully. The operative duration was 45–150 min and blood loss was negligible. There were no conversions to conventional multi‐port laparoscopy or open surgery. Recovery was uneventful with only minor complications in two patients; convalescence was rapid.CONCLUSION
LESS nephrectomy offers a safe, cosmetic alternative to conventional multi‐port laparoscopy, with younger female patients being especially happier with the ‘scarless’ outcome of U‐LESS. LESS certainly appears to be more in these situations. 相似文献12.
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Significant energy has been applied to development of minimally-invasive techniques in surgery to decrease morbidity, improve cosmesis, and hasten postoperative convalescence without compromising surgical outcomes. The evolution of laparoscopy has revolutionized simple, radical and donor nephrectomy in appropriately selected patients, exchanging large flank and abdominal incisions for small "keyhole" incisions. Surgeons continue to pursue innovative approaches to minimize the morbidity of procedures. Natural orifice translumenal endoscopic surgery (NOTES) eliminates entirely the need for abdominal incisions, while laparoendoscopic single-site (LESS) surgery permits placement of multiple instruments through a single incision. Together, they represent two novel approaches developed within the last decade that have been successfully applied to nephrectomy in both the laboratory and clinical settings. Here, the transvaginal and LESS approaches to nephrectomy are reviewed. 相似文献
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TH Oh 《Korean journal of urology》2012,53(7):443-450
Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. Laparoendoscopic single-site surgery (LESS) potentially takes this further. Following the first human urological LESS report in 2007, numerous case series have emerged, as well as comparative studies comparing LESS with standard laparoscopy. However, comparative series between conventional laparoscopy and LESS for different procedures suggest a non-inferiority of LESS over standard laparoscopy, but the only objective benefit remains an improved cosmetic outcome. Challenging ergonomics, instrument clashing, lack of true triangulation, and in-line vision are the main concerns with LESS surgery. Various new instruments have been designed, but only experienced laparoscopists and well-selected patients are pivotal for a successful LESS procedure. Robotic-assisted LESS procedures have been performed. The available robotic platform remains bulky, but development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery. 相似文献
15.
Liatsikos E Kyriazis I Kallidonis P Do M Dietel A Stolzenburg JU 《World journal of urology》2012,30(5):581-587
Purpose
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.Methods
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.Results
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.Conclusion
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. 相似文献16.
Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice 总被引:1,自引:1,他引:0
Mikael H. Sodergren James Clark Thanos Athanasiou Julian Teare Guang-Zhong Yang Ara Darzi 《Surgical endoscopy》2009,23(4):680-687
Background Natural orifice translumenal endoscopic surgery (NOTES), with its focus on eliminating incision-related complications, promises
to revolutionize the way surgery is performed. This study aimed to summarize the clinical applications of NOTES for humans,
outline the techniques used, and discuss the complications and limitations of current techniques.
Methods A literature search was performed using PubMed and Medline search tools to review the extent and outcomes of human procedures
undertaken using the NOTES technique in its pure form or as a hybrid procedure reported until July 2008. The end points were
the types of operation performed, the approach and technique used for each operation, and the procedure-related complications
and technical limitations.
Results This review considered 16 publications reporting on 49 human subjects. All the studies except three used hybrid NOTES procedures,
with varying amounts of transabdominal assistance. Three transvaginal cholecystectomies, one transvaginal appendectomy, and
eight transgastric appendectomies have been performed using a pure NOTES technique. To date, 15 NOTES transvaginal cholecystectomies
and 10 NOTES appendectomies (8 transgastric and 2 transvaginal) are reported. Other procedures including peritoneoscopy and
sigmoid colectomy are described. Three cases of minor morbidity are reported and no mortality.
Conclusions Although initial human results seem encouraging, it is important that this research be conducted in a way that minimizes bad
publicity and describes both favorable and adverse outcomes. Robust trials must be conducted at established centers with appropriate
experience and institutional board ethical review to allow safe introduction of this novel technique, with adequate and expedient
reporting of serious adverse events. The limitations of the current tools and methods are discussed, and suggestions are made
for further improvements in the technology to facilitate NOTES operations. 相似文献
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�����Σ��� ΰ 《中国实用外科杂志》2011,31(1):29-31
经自然孔道内镜外科(natural orifice transluminal endoscopic surgery,NOTES)经过近10年的研究,已经由一个理想中的概念走向初步的临床应用.由于其尚存在诸多较难克服的技术瓶颈,现阶段仍无法广泛开展.经脐单孔腔镜手术是目前最现实可行的"无瘢痕"技术.该技术近年来在国内外进... 相似文献
18.
Background
Natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-port surgery (LESS) are emerging approaches to abdominal surgery that have been advocated as potentially causing fewer physiologic derangements and less pain. This study aimed to compare these procedures in a novel rat model by assessing peritoneal inflammation, gastric motility, and nociception in response to peritoneoscopy performed via NOTES and LESS. 相似文献19.
J. Bachiller Burgos J. Alonso Flores J. Sánchez De La Vega V. Beltrán Aguilar S. Salazar Otero C. Bras Silva 《Actas urologicas espa?olas》2010,34(6):495-499
Since 2007, various urological procedures have been performed with laparoendoscopic single-site surgery (LESS surgery), including nephrectomy, pyeloplasty, simple prostatectomy and, with the refinement of laparoscopic instrumentation, radical prostatectomy. This paper reports our initial experience in radical prostatectomy using the SILS? Port from Covidiem and two lateral 5-mm trocars for triangulation. The SILS? Port allows for accurate, simple insertion through a Hadson incision. The flexible port accomodates three 5-mm cannulas or two 5-mm cannulas and a 12-mm port for easier instrument exchange through a single incision. This approach decreases morbidity from bleeding, hernia and/or internal organ damage and improves cosmetic results.One-port single-incision laparoscopy is part of the natural development of minimally invasive surgery. Future research is required to assess the intraoperative and postoperative benefits of LESS surgery as compared to standard laparoscopy. 相似文献
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Florian Imkamp Thomas R. W. Herrmann Jens U. Stolzenburg Jens Rassweiler Tullio Sulser Uwe Zimmermann Sebastian Dziuba Markus A. Kuczyk Martin Burchardt 《World journal of urology》2014,32(6):1363-1374