title: [Is LESS/NOTES surgery the new gold standard of minimally invasive surgery?].
abstract: Over the last 20 years surgery has suffered a dramatic change. We saw how open surgery was almost replaced by laparoscopic surgery and this latter has  evolved to minimally invasive surgical techniques such as LaparoEndoscopic Single-site Surgery (LESS) and NOTES ((Natural  Orifice Transluminal  Endoscopic Surgery). These minimally invasive operations try to maximally reduce the size and number of abdominal scars in order to minimize morbidity, reducing  surgical aggression and therefore the need for analgesia during the postoperative period, and they offer excellent cosmetic results. LESS surgery implies  the performance of intra-abdominal surgery through a single 3-4 cm incision, through which laparoscopic instruments are introduced. This  may be  considered the next step in the evolution of laparoscopic surgery advancing to the ideal of scarless surgery. This modality is having great acceptance,  since it allows the insertion of an extra trocar at any time transforming it in conventional laparoscopic surgery. Furthermore, when performing the  incision within the umbilical scar, it enables concealing the incision in it at the end of the operation, achieving very good cosmetic results. NOTES  surgery would be another step forward. Pure NOTES techniques in the field of Urology are very complex to perform today with the available equipment.  Hybrid NOTES and assisted NOTES are variations described which have demonstrated they are viable and offer very good cosmetic results and lower  morbidity.  Regarding this, the vaginal approach offers a good working channel that can also be used for specimen extraction. Recent  published studies confirm the feasibility and reproducibility of both techniques in urologic surgery, specifically in the treatment of renal cancer,  with comparable results to conventional laparoscopic surgery.
authors: Servicio de Urología, Hospital Clínico, Barcelona, España.
authors: Mireia
authors: M
authors: Musquera
authors: Lluís
authors: L
authors: Peri
authors: Laura
authors: L
authors: Izquierdo
authors: Eduardo
authors: E
authors: García
authors: María José
authors: MJ
authors: Ribal
authors: Antonio
authors: A
authors: Alcaraz
mesh_terms: D006801:Humans; D007668:Kidney / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000379:methods*