title: Transumbilical single-port surgery: evolution and current status.
abstract: BACKGROUND
  Single-port transumbilical laparoscopy, also known as embryonic natural orifice transumbilical endoscopic surgery (E-NOTES), has emerged as an attempt to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. Within a short span, several clinical reports have emerged in the urologic literature. As this field is poised to move forward, a complete understanding of its evolution and current status is timely.
  
  
  OBJECTIVE
  To summarize and review the history of E-NOTES across surgical disciplines. This review emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes. Specific urological and nonurological applications of single-port surgery to date are summarized.
  
  
  METHODS
  Using the National Library of Medicine database, the English-language literature was reviewed for the past 40 yr. Keyword searches included: scarless, scar free, single port/trocar/incision, intraumbilical, and transumbilical. Within the bibliography of selected references, additional sources were retrieved.
  
  
  RESULTS
  The gynecologic and general surgical literature includes approximately 19 papers fulfilling the search criteria, encompassing extirpative procedures only. The urologic literature contains eight published reports of single-trocar transumbilical procedures. These reports are summarized in a chronological manner and grouped by subject. No prospective studies comparing outcomes to standard laparoscopy have been reported. Technical feasibility has been demonstrated for a broad range of extirpative and reconstructive procedures on the upper and lower urinary tracts, including simple and radical nephrectomy, donor nephrectomy, renal cryotherapy, pyeloplasty, ileal ureteral replacement, sacrocolpopexy, and varicocelectomy.
  
  
  CONCLUSIONS
  E-NOTES has made its initial forays into laparoscopic surgery. Ongoing refinement in technique and instrumentation is likely to expand its future role.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. canesd@ccf.org
authors.forename: David
authors.initials: D
authors.lastname: Canes
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Raj K
authors.initials: RK
authors.lastname: Goel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000818:Animals; D004867:Equipment Design; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D020706:Laparoscopes / Q000639:trends*; D010535:Laparoscopy / Q000379:methods* / Q000639:trends; D014472:Umbilicus; D013520:Urologic Surgical Procedures / Q000379:methods*