Where do we really stand with LESS and NOTES?

Abstract

[Excerpt] Urologists are increasingly aware of new surgical concepts including natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) [1–5]. In 2008, the Urology LESS and NOTES Working Group was formed under the auspices of the Endourological Society. In addition to having a stated goal of increasing awareness about LESS and NOTES, the working group also wanted to define nomenclature, guide scientific evaluation, and provide opportunities for safe clinical implementation [6]. In 2010, the European Society of Urotechnology similarly formed a working group dedicated to LESS and NOTES. In this paper, we report progress on the stated goals and make new recommendations for the future of LESS and NOTES in urology. To date, progress has been made with all stated goals. Nomenclature for LESS and NOTES has been clearly defined [7,8]. In addition, most urologists are now aware of the concepts of LESS and NOTES [1,3,4,8]. Society in general is also interested and largely supportive of the LESS and NOTES concepts [9,10]. Although savvy patients may be interested in LESS and NOTES procedures, we are always obligated to place the needs of the patient first when determining surgical approach. It may sound very appealing to the patient to have no visible surgical scars, but the same patient is less interested in the so-called scarless approach if the risk of complications or morbidity is significantly increased [9–11]. As such, the development of these nascent approaches should be methodical and the recommendations based on objective data. [...]