title: New trends in minimally invasive urological surgery: what is beyond the robot?
abstract: OBJECTIVE
  To review the minimal-invasive development of surgical technique in urology focusing on nomenclature, history and outcomes of Laparo-Endoscopic Single-site Surgery (LESS), Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Computer-Assisted Surgery (CAS).
  
  
  METHODS
  A comprehensive literature search was conducted in order to find article related to LESS, NOTES and CAS in urology. The most relevant papers over the last 10 years were selected in base to the experience from the panel of experts, journal, authorship and/or content.
  
  
  RESULTS
  Seven hundred and fifty manuscripts were found. Papers on LESS describe feasibility/safety in most of the procedures with a clinical experience of more than 300 cases and five compared results to standard laparoscopy without showing significant differences. NOTES accesses have been proved their feasibility/safety in experimental study. In human, the only procedures performed are on kidney and through a hybrid-Transvaginal route. New robots overcome the main drawbacks of the DaVinci® platform. The use of CAS is increasing its popularity in urology.
  
  
  CONCLUSIONS
  LESS has been applied in clinical practice, but only ongoing technical and instrumental refinement will define its future role and overall benefit. The transition to a clinical application of NOTES seems at present only possible with multiple NOTES access and transvaginal access. Robot and Soft Tissue Navigation appear to be important to improve surgical skills. We are already witness to the advantages offered by the former even if costs need to be redefined based on pending long-term results. The latter will probably upgrade the quality of surgery in a near future.
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Via del pozzo 71, 41100, Modena, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Giovannalberto
authors.initials: G
authors.lastname: Pini
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Sighinolfi
authors.forename: Stefano
authors.initials: S
authors.lastname: De Stefani
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
mesh_terms: D004724:Endoscopy / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000639:trends*; D012371:Robotics / Q000639:trends*; D025321:Surgery, Computer-Assisted / Q000639:trends; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000639:trends*
references.citation: Urology. 2009 Oct;74(4):801-4
references.pmid: 19615721
references.citation: Gastrointest Endosc. 2006 Sep;64(3):428-34
references.pmid: 16923495
references.citation: Urology. 2009 Nov;74(5):1029-34
references.pmid: 19660793
references.citation: Urology. 2009 Jun;73(6):1371-4
references.pmid: 19362340
references.citation: J Urol. 2007 Dec;178(6):2648-54
references.pmid: 17945287
references.citation: Mayo Clin Proc. 2007 Jul;82(7):843-5
references.pmid: 17605965
references.citation: BJU Int. 2008 Dec;102(11):1715-8
references.pmid: 18778358
references.citation: J Endourol. 2007 Jun;21(6):640-4
references.pmid: 17638562
references.citation: Eur Urol. 2010 Jan;57(1):138-44
references.pmid: 19406563
references.citation: Int J Urol. 2010 May;17(5):410-31
references.pmid: 20236371
references.citation: Eur Urol. 2010 Feb;57(2):233-7
references.pmid: 19775806
references.citation: Curr Opin Urol. 2007 May;17(3):151-5
references.pmid: 17414511
references.citation: Urology. 2009 Nov;74(5):1049-53
references.pmid: 19758685
references.citation: J Urol. 2006 Aug;176(2):802-5
references.pmid: 16813951
references.citation: Eur Urol. 2009 May;55(5):1163-9
references.pmid: 19185415
references.citation: Eur Urol. 2009 Oct;56(4):644-50
references.pmid: 19576681
references.citation: J Urol. 2008 Nov;180(5):2202-5
references.pmid: 18804807
references.citation: Urology. 2010 Jan;75(1):100-3
references.pmid: 19628259
references.citation: J Endourol. 2009 May;23(5):759-64
references.pmid: 19405809
references.citation: Eur Urol. 2009 May;55(5):1198-204
references.pmid: 18715694
references.citation: J Endourol. 2009 Dec;23(12):1957-60
references.pmid: 19909074
references.citation: J Endourol. 2008 Nov;22(11):2575-81
references.pmid: 19046097
references.citation: J Endourol. 2008 Apr;22(4):803-10
references.pmid: 18366316
references.citation: Gastrointest Endosc. 2004 Jul;60(1):114-7
references.pmid: 15229442
references.citation: Urology. 2009 Apr;73(4):896-900
references.pmid: 19193404
references.citation: J Endourol. 2008 Apr;22(4):751-66
references.pmid: 18366319
references.citation: Surg Endosc. 2009 Feb;23(2):260-6
references.pmid: 19057960
references.citation: Eur Urol. 2009 Aug;56(2):332-8
references.pmid: 19477580
references.citation: Eur Urol. 2008 Jun;53(6):1290-4
references.pmid: 17997020
references.citation: Curr Opin Urol. 2009 Jan;19(1):108-13
references.pmid: 19057226
references.citation: Eur Urol. 1993;24(1):116-7
references.pmid: 8365431
references.citation: Gastrointest Endosc. 2007 Feb;65(2):312-8
references.pmid: 17173916
references.citation: Urology. 2002 Mar;59(3):446-50
references.pmid: 11880100
references.citation: Eur Urol. 2010 Jan;57(1):95-101
references.pmid: 19664877
references.citation: Urology. 2009 Oct;74(4):805-12
references.pmid: 19643465
references.citation: Urology. 2008 Jun;71(6):996-1000
references.pmid: 18455769
references.citation: BJU Int. 2010 Mar;105(5):686-90
references.pmid: 19912198