Urological applications of N.O.T.E.S. |
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| Authors: | L Cindolo S Gidaro L Schips |
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| Institution: | 1. Urology Unit, “S. Pio da Pietrelcina” Hospital, Vasto (CH), Italy;2. Department of Surgical and Experimental Sciences, Chieti-Pescara University, Italy;1. Division of Pediatric Cardiac Surgery, Seattle Children''s Hospital, Seattle, Washington;2. Division of Pediatric Cardiology, Seattle Children''s Hospital, Seattle, Washington;1. College of Textiles, North Carolina State University, Raleigh, North Carolina;2. College of Textiles, Donghua University, Shanghai, China;3. Department of Radiology, Centre Hospitalier de l’Université de Montréal Research Centre, Montreal, Quebec, Canada;4. Centre Hospitalier de l’Université de Montréal Hôpital Notre-Dame, and Laboratory of Biorheology and Medical Ultrasonics, Centre Hospitalier de l’Université de Montréal Research Centre, Montreal, Quebec, Canada;5. Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal, Montreal, Quebec, Canada;6. Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada;7. Division of Vascular and Interventional Radiology, Peter Munk Cardiac Centre, University Health Network, E6-220, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada;8. Joint Department of Medical Imaging, and Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, E6-220, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada;1. Division of Cardiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania;2. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California;3. Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh of University of Pittsburg Medical Center, Pittsburgh, Pennsylvania;4. Division of Pediatric Cardiology, Yale University, New Haven, Connecticut;5. Department of Pediatric Cardiology, Rady Children''s Hospital, University of California San Diego, San Diego, California;6. Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, München, Germany;7. Department of Pediatric Cardiology, Miami Children’s Hospital, Miami, Florida;8. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark;9. Division of Cardiology, Seattle Children’s Hospital, Seattle, Washington;1. Department of Urology, Humanitas Mater Domini, Castellanza VA, Italy;2. ALF-X Surgical Robotics Department, SOFAR SpA, Milan, Italy |
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| Abstract: | While adrenal and kidney urological surgery has been performed in animal models mainly by transvesical accesses, to date, NOTES in humans remains in an investigational and developmental phase. Despite great experimental interest, no specific devices are currently available for urological indications in humans and therefore several instruments, taken from different specialist fields, have been used to access through the different natural orifices (including transgastric, transcolonic, transvaginal and transvesical approaches). Furthermore, the accumulating experience with the transvesical approach to the peritoneum suggests it presents new challenges for urologists in terms of technical demands. For these reasons, given their competition with the success of laparoscopy and minimally invasive techniques, NOTES applications in urology risk being underevaluated. In our opinion, after the initial enthusiastic phase, NOTES will cover only specific indications for urological conditions. The transvesical approach to the peritoneum however seems to be one of the best approaches for NOTES overall and certainly the most promising for urologists. |
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