Abstract
Introduction
Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) are the next steps in the evolution of laparoscopic surgery, promising reduced morbidity and improved cosmetic result. The inconsistent terminology initially used led to confusion. Understanding the technical evolution, the current status and a unified and simplified terminology are key issues for further acceptance of both approaches.
Objective
To present LESS and NOTES in its historical context and to clarify the associated terminology.
Method
Extensive literature search took place using the PubMed. Several hundred publications in general surgery and urology regarding LESS are present including the expert opinion of members the European Society of Uro-technology (ESUT).
Results
The increasing interest on NOTES and LESS is reflected by a raising number of publications during the last 4 years. The initial confusion with the terminology of single-incision surgery represented a significant issue for further evolution of the technique. Thus, consortiums of experts searched a universally acceptable name for single-incision surgery. They determined that ‘laparoendoscopic single-site surgery’ (LESS) was both scientifically accurate and colloquially appropriate, the term being also ratified by the NOTES working group (Endourological Society) and the ESUT. For additional use of instruments, the terms hybrid NOTES and hybrid LESS should be used. Any single use of miniaturized instruments for laparoscopy should be called mini-laparoscopy.
Discussion
The evolution of LESS and most likely NOTES to a new standard of minimally invasive surgery could represent an evolutionary step even greater than the one performed by the establishment of laparoscopy over open surgery.
Similar content being viewed by others
References
Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Roemer FD, Pingleton ED, Thomson PG, Long SR (1991) Laparoscopic nephrectomy: initial case report. J Urol 146:278–282
Rassweiler J, Fornara P, Weber M, Janetschek G, Fahlenkamp D, Henkel T, Beer M, Stackl W, Boeckmann W, Recker F, Lampel A, Fischer C, Humke U, Miller K (1998) Laparoscopic nephrectomy: the experience of the laparoscopic working group of the German Urologic Association. J Urol 160:18–21
Rassweiler J, Frede T, Henkel TO, Stock C, Alken P (1998) Nephrectomy: a comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach. Eur Urol 33:489–496
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard J, Mulders PFA, Sinescu IC (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58:398–406. doi:10.1016/j.eururo.2010.06.032
Guideline for Management of the Clinical Stage 1 Renal Mass (2009) 2009 American Urological Association Education and Research, Inc
Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR, Frank I, Permpongksol S, Weight CJ, Kaouk JH, Kattan MW, Novick AC (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46. doi:10.1016/j.juro.2007.03.038
Lane BR, Gill IS (2010) 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol 183:473–479. doi:10.1016/j.juro2009.10.023
Bratzler DW, Houck PM (2005) Surgical infection prevention guideline writers workgroup. Antimicrobial prophylaxis for surgery: an advisory statement from the national surgical infection prevention project. Am J Surg 189:395–404
George AK, Srinivasan AK, Cho J, Sadek MA, Kavoussi LR (2011) Surgical site infection rates following laparoscopic urological procedures. J Urol 185:1289–1293. doi:10.1016/j.juro.2010.11.059
O’Dwyer PJ, Courtney CA (2003) Factors involved in abdominal wall closure and subsequent incisional hernia. Surgeon 1:17–2215
Nezhat C, Nezhat F, Seidman DS (1997) Incisional hernias after operative laparoscopy. J Laparoendosc Adv Surg Technol A 7:111–115
Soble JJ, Gill IS (1998) Needlescopic urology: incorporating 2-mm instruments in laparoscopic surgery. Urology 52:187–194
Pini G, Goezen AS, Schulze M, Klein JT, Rassweiler JJ (2011) Small-incision access retroperitoneoscopic technique (SMART) pyeloplasty in adult patients: comparison of cosmetic and postoperative pain outcomes in a matched-pair analysis with standard retroperitoneoscopic pyeloplasty: preliminary report. Wold J Urol. Epub ahead of print. doi:10.1007/s00345-011-0740-x
Pini G, Porpiglia F, Micali S, Rassweiler J (2012) Minilaparoscopy, needlescopy and microlaparoscopy: decreasing invasiveness, maintaining the standard laparoscopic approach. Arch Esp Urol 65:366–383
Box G, Averch T, Cadeddu J et al (2008) Nomenclature of natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) procedures in urology. J Endourol 22:2575–2581. doi:10.1089/end.2008.0471
Kalloo AN, Singh VK, Jagannath SB et al (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117
Gettman MT, Lotan Y, Napper CA, Cadeddu JA (2002) Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 59:446–450
Prashanth P, Pradeep PR, SonaliBhagwat (2011) Single-incision laparoscopic surgery—current status and controversies. J Minim Access Surg 7:6–16
Lima E, Rolanda C, Pego JM, Henriques-Coelho T, Silva D, Carvalho JL, Correia-Pinto J (2006) Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery. J Urol 176:802–805. doi:10.1016/j.juro.2006.03.075
Lima E, Branco F, Parente J, Autorino R, Correia-Pinto J (2011) Transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney morcellation: a proof of concept study. BJU Int. Epub ahead of print, doi:10.1111/j.1464-410X.2011.10772x
Baldwin DD, Tenggardjaja C, Bowman R, Ebrahimi K, Hans DS et al (2011) Hybrid transureteral natural orifice translumenal endoscopic nephrectomy: a feasibility study in the porcine model. J Endourol 25:245–250
Bazzi WM, Wagner O, Stroup SP, Silberstein JL et al (2011) Transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in porcine model. Urology 77:518–523
Autorino R, Haber GP, White MA et al (2010) Pure and hybrid natural orifice transluminal endoscopic surgery (NOTES): current clinical experience in urology. BJU int 106:919–922
Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, Lima E, Montorsi F, Richstone I, Stolzenburg JU, Kaouk JH (2011) Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 59:26–45. doi:10.1016/j.eururo.2010.08.000030
Porpiglia F, Flori C, Morra I, Scarpa RM (2011) Transvaginal natural orifice transluminal endoscopic-assisted minilaparoscopic nephrectomy: a step towards scarless surgery. Eur Urol 60:862–866. doi:10.1016/j.eururo.2010.09.038
Alcaraz A, Peri L, Molina A, Goicoechea I, Garcia E, Izquierdo L, Ribal MJ (2010) Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy. Eur Urol 57:233–237. doi:10.1016/j.eururo.2009.09.025
Alcaraz A, Musquera M, Peri L, Izquierdo L, García-Cruz E, Huguet J, Alvarez-Vijande R, Campistol JM, Oppenheimer F, Ribal MJ (2011) Feasibility of transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy: is kidney vaginal delivery the approach of the future? Eur Urol 59:1019–1025
Rassweiler JJ (2011) Is LESS/NOTES really more? Eur Urol 59:46–50. doi:10.1016.j.eururo.2010.08.040
Wheeless CR (1969) A rapid, inexpensive and effective method of surgical sterilization by laparoscopy. J Reprod Med 5:255–257
Junker H (1974) Laparoscopic tubal ligation by the single puncture technique (author’s transl) Geburtshilfe Frauenheilkunde 34:952–955
Buess G, Kipfmüller K, Hack D, Grüssner R, Heintz A, Junginger T (1988) Technique of transanal endoscopic microsurgery. Surg Endosc 2:71–75
Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA (2007) Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 70:1039–1042
Rane A, Rao P, Bonadio F, Rao P (2007) Single port laparoscopic nephrectomy using a novel laparoscopic port (R-port) and evolution of single laparoscopic port procedure (SLIPP). J Endourol 21:A287 Abstract
Micali S, Pini G, Teber D, Sighinolfi MC, De Stefani S, Bianchi G, Rassweiler J (2010) New trends in minimally invasive urologic surgery. What is beyond the robot? World J Urol. Epub ahead of print, doi:10.1007/s00345-010-058-5
Liatsikos E, Kyriazis I, Kallidonis P, Do M, Dietel A, Stolzenburg JU (2011) Pure single-port laparoscopic surgery or mix of techniques? World J Urol. (Epub ahead of print)
Jeong BC, Park YH, Han DH, Kim HH (2009) Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study. J Endourol 23:1957–1960. doi:10.1089=end.2009.12.029
Canes D, Berger A, Aron M, Brandina R, Goldfarb DA, Shoskes D, Desai MM, Gill IS (2010) Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 57:95–101. doi:10.1016.j.eururo.2009.09.016
Stolzenburg JU, Do M, Haefner T, Dietel A, Kallidonis P, Kyriazis I, Beatty J, Liatsikos EN (2011) Laparoendoscopic single-site surgery radical nephrectomy. J Endourol 25(2):159–165
Rabenalt R, Arsov C, Giessing M, Winter C, Albers P (2010) Extraperitoneal laparo-endoscopic single-site radical prostatectomy: first experience. World J Urol 28(6):705–708. doi:10.1007/s00345-010-0543-6
Aron M, Canes D, Desai MM et al (2009) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103:516–521
Gill IS, Canes D, Aron M et al (2008) Single port transumbilical (E-NOTES) donor nephrectomy. J Urol 180:637–641
Desai MM, Stein R, Rao P, Canes D, Aron M, Rao PP, Haber GP, Kaouk JH, Fergany A, Gill IS (2009) Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience. Urology 73:127–182
Breda A, Villamizar JM, Faba OR, Caliolo C, de Gracia A, Gausa L, de Leon JP, Villavicencio H (2012) Laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope: initial experience at a tertiary center. Eur Urol 61:840–844
Kaouk JH, Goel RK (2009) Single-port laparoscopic and robotic partial nephrectomy. Eur Urol 55:1163–1169. doi:10.1016/j.eururol.2008.12.029
White MA, Haber GP, Autorino R, Khana R, Forest S, Yang B, Altunreide F, Stein RJ, Kaouk JH (2010) Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol 58:544–550. doi:10.1016/J.eururo.2010.06.040
Kaouk JH, Autorino R, Laydner H, Hillyer S, Yakoubi R, Isac W, Kassab A, Rizkala E, Stein RJ (2012) Robotic single-site kidney surgery: evaluation of second-generation instruments in a cadaver Model. Urology 79:575–579
Cestari A, Buffi NM, Lista G, Lughezzani G, Larcher A, Lazzeri M, Sangalli M, Rigatti P, Guazzoni G (2012) Feasibility and preliminary clinical outcomes of robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-port platform. Eur Urol. (Epub ahead of print)
Haber GP, Autorino R, Laydner H, Yang B, White MA, Hillyer S, Altunrende F, Khanna R, Spana G, Wahib I, Farred K, Stein RJ, Kaouk JH (2012) SPIDER surgical system for urologic procedures with laparoendoscopic single-site surgery: form initial laboratory experience to first clinical application. Eur Urol 61:415–422. doi:10.1016/j.eururo.2011.011.030
Pini G, Rassweiler J (2012) Minilaparoscopy and laparoendoscopic single-site surgery:mini- and single scar in urology. Min Inv Ther 21:8
Sooriakumaran P, Kommu SS, Rane A (2008) NOTES, SILS and OPUS: battle of the acronyms for the future of laparoscopic urology. Int J Clin Pract 62:988
Gettman MT, Box G, Averch T, Cadeddu JA, Cherullo E, Clayman RV, Desai M, Frank I, Gill I, Gupta M (2008) Consensus statement on natural orifice transluminal endoscopic surgery and single-incision laparoscopic surgery: heralding a new era in urology? Eur Urol 53:1117–1120. doi:10.1016/j.eururo.2008.02.0006
Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo PG et al (2010) Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 24:22–762
Gettman MT, White WM, Aron M, Autorino R, Averch T, Box G, Cadeddu JA, Canes D, Cherullo E, Desai MM, Frank I, Gill IS, Gupta M, Haber GP, Humphreys MR, Irwin BH, Kaouk JH, Kavoussi LR, Landman J, Liatsikos EN, Lima E, Ponsky LE, Rane A, Ribal M, Rabenalt R, Rao P, Richstone L, Sawyer MD, Sotelo R, Stolzenburg JU, Tracy CR, Stein RJ, Endourological Society NOTES and LESS Working Group, European Society of Urotechnology NOTES and LESS Working Group (2011) Where do we really stand with LESS and NOTES? Eur Urol 59:231–234. doi:10.1016/j.eururo.2010.11.016
Walz MK, Groeben H, Alesina PF (2010) Single-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case-control study. World J Surg 34(6):1386–1390
Micali S, Isgrò G, De Stefani S, Pini G, Sighinolfi MC, Bianchi G (2010) Retroperitoneal laparoendoscopic single-site surgery: preliminary experience in kidney and ureter. Eur Urol 59:164–167. doi:10.1016/j.eururo.200.08.002
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors A. N. Georgiou, J. Rassweiler and M. Burchardt contributed equally to this article.
Rights and permissions
About this article
Cite this article
Georgiou, A.N., Rassweiler, J., Herrmann, T.R. et al. Evolution and simplified terminology of natural orifice transluminal endoscopic surgery (NOTES), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). World J Urol 30, 573–580 (2012). https://doi.org/10.1007/s00345-012-0899-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-012-0899-9