title: Natural Orifice Transluminal Endoscopic Surgery-Assisted Laparoscopic Transvesical Bladder Diverticulectomy: Feasibility Study, Points of Technique, and Case Series with Medium-Term Follow-Up.
abstract: To demonstrate the feasibility of our novel natural orifice transluminal endoscopic surgery (NOTES)-assisted approach with medium-term follow-up.
  
  
  
  From March 2012, we included all patients who presented to our clinic with symptomatic or complicated retentive bladder diverticula secondary to long-standing infravesical obstruction. After managing the primary cause, we proceeded in all cases to our novel NOTES-assisted approach. We followed up the patients with abdominal ultrasonography at 6 weeks and 12 months postoperatively. Success was determined as subjective relief of the symptoms and objective disappearance of the diverticula in postoperative retrograde cystogram (RGC).
  
  
  
  Between March 2012 and August 2014, eight diverticula were treated using our new technique. The surgery was uneventful. The mean operative time was 134.25 ± 44.92 minutes. Blood loss was minimal (>50 mL). Retrograde cystography was performed on the 10th postoperative day. The introduction of the needle holder through the urethral natural orifice (NOTES) facilitated a more optimal direction of the needle holder for suturing the bladder wall due to its parallel position in relation to the trigone and posterolateral walls. This renders this step easier compared with suturing the bladder wall through the transvesical laparoscopic ports. One case had a grade IIIa complication according to the Clavien-Dindo classification of surgical complications. The study is limited by the small number of cases.
  
  
  
  Laparoscopic transvesical bladder diverticulectomy is a promising and safe procedure with good outcomes. Using the urethra (NOTES assisted) as an extra access to the bladder facilitates diverticular traction and bladder suturing without the need for extra ports. This technique can also be applied together with the novel T-laparoendoscopic single-site surgery approach.
authors.affiliation: 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .|2 Urology and Andrology Department, Faculty of Medicine, Menoufia University, Egypt .
authors.forename: Ahmed
authors.initials: A
authors.lastname: Magdy
authors.affiliation: 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .
authors.forename: Martin
authors.initials: M
authors.lastname: Drerup
authors.affiliation: 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .
authors.forename: Sophina
authors.initials: S
authors.lastname: Bauer
authors.affiliation: 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .
authors.forename: Daniela
authors.initials: D
authors.lastname: Colleselli
authors.affiliation: 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .
authors.forename: Stephan
authors.initials: S
authors.lastname: Hruby
authors.affiliation: 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .
authors.forename: Michael
authors.initials: M
authors.lastname: Mitterberger
authors.affiliation: 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .
authors.forename: Günter
authors.initials: G
authors.lastname: Janetschek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004240:Diverticulum / Q000601:surgery*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000002:abnormalities* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult