Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience.

Abstract

OBJECTIVES:

Natural orifice transluminal endoscopic surgery comprises intraabdominal surgery performed by way of natural orifices (ie, vagina, mouth). In a similar manner, the umbilicus provides an embryonic natural orifice that permits intraabdominal access. We report on the feasibility of performing single-port advanced laparoscopic reconstructive surgery by way of the umbilicus in 6 patients. We propose the terminology embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) for this novel surgical approach.

METHODS:

Through a single 1.5- to 3-cm intraumbilical incision and a novel, single-access port, we performed laparoscopic bilateral single-session Anderson-Hynes pyeloplasty (2 patients, 4 procedures), ileal ureter (n = 1), and ureteroneocystostomy with a psoas hitch (n = 1). No extraumbilical skin incisions were used. A 2-mm Veress needle port, inserted through a skin needle puncture, was used to create the pneumoperitoneum and to selectively insert a needlescopic grasper to assist in suturing.

RESULTS:

All procedures were successful without the need for any additional laparoscopic ports. For the 2 patients undergoing bilateral pyeloplasty (including patient repositioning) and the 1 patient each undergoing ileal ureter and psoas-hitch ureteroneocystostomy, the operating time was 4.5, 6, 5, and 3 hours, blood loss was 100, 50, 75, and 50 mL, and the hospital stay was 1, 2, 3, and 2 days, respectively. No intraoperative or postoperative complications developed.

CONCLUSIONS:

To our knowledge, we present the initial experience with advanced laparoscopic reconstruction through a single intraumbilical port. Additional refinement of this technology could lead to wider incorporation of single-port laparoscopy in clinical practice. Embryonic-natural orifice transluminal endoscopic surgery appears to be a promising new approach for select indications.

• Authors: Mihir M Desai, Robert Stein, Prashanth Rao, David Canes, Monish Aron, Pradeep P Rao, Georges-Pascal Haber, Amr Fergany, Jihad Kaouk, Inderbir S Gill
• Journal: Urology (Urology) Vol. 73 Issue 1 Pg. 182-7 (Jan 2009) ISSN: 1527-9995 [Electronic] United States
• PMID: 18799203 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Endoscopy (methods)
• Female
• Humans
• Kidney Pelvis (surgery)
• Laparoscopy (methods)
• Male
• Middle Aged
• Umbilicus