New trends in minimally invasive urological surgery: what is beyond the robot?
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.
Micali
Salvatore
S
Department of Urology, University of Modena and Reggio Emilia, Via del pozzo 71, 41100, Modena, Italy.
Pini
Giovannalberto
G
Teber
Dogu
D
Sighinolfi
Maria Chiara
MC
De Stefani
Stefano
S
Bianchi
Giampaolo
G
Rassweiler
Jens
J
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*
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