Transvaginal NOTES and LESS: Are They the Future in Kidney Surgery?

ContextIn the course of the development of minimally invasive surgeries over the past 20 yr, the new concept of scarless surgery has emerged. Laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) are included in this concept, and they are the evolution of laparoscopy towards minimising the impact of surgery on the patient.ObjectiveDescribe our experience with NOTES and LESS in the context of the latest publications on these techniques in kidney surgery to identify their role in current urologic practice.Evidence acquisitionOver the last 3 yr, we have performed 38 transvaginally NOTES, assisted, laparoscopic nephrectomies; 16 LESS radical nephrectomies; 2 LESS partial nephrectomies; and 1 LESS live-donor nephrectomy. This paper is based on a presentation at the 2011 meeting of the European Society of Oncological Urology; a bibliographic review also was performed to make a structured paper on the most recent advances in scarless renal surgery and to describe the role NOTES and LESS currently have in urology.Evidence synthesisNOTES is a surgical modality that uses empty organs to access the peritoneal cavity. Although pure NOTES is not available for kidney surgery yet, it eliminates abdominal scarring. The combination of NOTES with conventional laparoscopy results in a hybrid technique that maintains most of the advantages of NOTES, making it a very interesting option in kidney surgery in females. LESS concentrates all trocars and extraction incisions in one point, resulting in a small scar. It is feasible in a number of urologic procedures.ConclusionsThe implementation of new minimally invasive techniques is essential to optimise surgery outcomes and improve patients’ recovery. Both hybrid NOTES and LESS have proven their feasibility in renal surgery; however, we still do not have evidence that they can overcome laparoscopic surgery; prospective trials are required to further elucidate this question.