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Natural orifice transluminal endoscopic surgery designates a surgical procedure that utilizes one or more patent natural orifices of the body with the intention to puncture a hollow viscera in order to enter the abdominal cavity. First carried out at the beginning of the 2000s in experimental models, it can be considered the natural evolution of laparoscopy towards the ideal of scarless surgery, as the avoidance of a large abdominal scar is associated with better cosmetic results and better recovery. However, the technology currently available does not allow the performance of complete pure natural orifice transluminal endoscopic surgery procedures. The surgical tools used are not specially designed for this approach, so difficulties in retracting organs, bleeding control and clashing of instruments are the main obstacle surgeons face. For this reason, the current available technique is the so-called hybrid approach, where a natural orifice approach is combined with some abdominal trocars, using the natural orifice as the exit door for the specimen removal. As not many comparative studies have been published evaluating the advantages of natural orifice transluminal endoscopic surgery in front of traditional laparoscopic surgery, a review of the history of natural orifice transluminal endoscopic surgery, and an assessment of the available evidence of this technique regarding renal and urological pelvic surgery are performed in this article., (© 2013 The Japanese Urological Association.)

Laparoscopic surgery was developed at the end of the 1980s and has been utilized in almost all urologic surgical procedures. It offers the benefits of less invasiveness and earlier recovery than open surgery. The introduction of laparoendoscopic single-site surgery has offered reduced pain and improved cosmetic satisfaction to patients. Scarless nephrectomy has been realized with transvaginal natural orifice transluminal endoscopic surgery in women. The development of surgical robots has decreased the technical difficulty of complicated procedures, shortened the learning curve, and improved perioperative outcomes relative to laparoscopic surgery. Surgical navigation using real-time sonography, augmented reality, fluorescence, or radioisotope images will improve the quality of these surgeries., (© 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.)

Purpose: Laparoendoscopic single-site surgery (LESS) has emerged in the recent years as an alternative approach to conventional laparoscopic surgery which is accompanied by additional advantages over laparoscopy. In this work we attempt to review the current literature and to investigate the possible combination of LESS to other currently available approaches such as natural orifice transluminal endoscopic surgery (NOTES), needlescopic and robotic laparoscopic surgery., Methods: Extensive literature search on the topics of LESS, hybrid and pure NOTES, Needlescopic-assisted LESS and "Robot-assisted LESS" took place. Additionally, the accumulated experience from 118 LESSs performed in our departments is presented in an attempt to provide evidence regarding the mix of technique in LESS in urology., Results: The challenging nature of LESS limits the broader application and acceptance. Expanding experience in single-site surgery has currently provided tools such as transvaginal access, needlescopic instruments and robot assistance that can aid LESS and enhance its efficiency without compromising any of its advantages. A mix of these techniques with LESS could ease the stiff learning curve of the second and benefit not only its performance but also the adaptation of LESS as a standard practice., Conclusion: Pure LESS although feasible, remains a technical challenge for the surgeon, preventing the widespread application of the technique. The goal of urologists on LESS surgery should not be the purity of LESS approach, but the superiority against already established techniques. A mix of techniques could be a key for the documentation of the advantages of LESS over conventional laparoscopy.

Rapid technological developments in the 1970's contributed to the emergence of operative laparoscopy as a revolution in surgery. In recent years, there has been a surge of interest in laparoendoscopic single-site (LESS) and natural orifice translumenal endoscopic surgery (NOTES), novel techniques that have the potential to further minimize the invasiveness and morbidity of surgery. Innovations in instrument design and in novel surgical platforms including robotic technology have rapidly been developed in an effort to enhance the future clinical applicability of these techniques. In this chapter, we review the current status and future directions of LESS and NOTES technology, focusing on the current research in the field.

This articles discusses the preclinical development of natural orifice surgery in urology. Rationale for this approach is provided. The description of transvaginal nephrectomy and NOTES prostatectomy is described.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) has emerged recently in the experimental surgical field, innovating for the passage of luminal barrier, the absence of scars and reduction of post-operative pain. Among the various ports of access (transvaginal, transgastric, transvesical and transcolonic), this paper is an update on advances & controversies of transvesical port for NOTES Urological applications.

Ten years ago the American gastroenterologist Anthony Kalloo described for the first time the concept of Natural Orifice Transluminal Endoscopic Surgery - NOTES. His revolutionary vision generated such an unprecedented worldwide momentum of creativity and renovation in the surgical community to push the current limit of the research in the minimal invasive surgery field toward the unimaginable goal of non visible scar surgery. At present time several NOTES applications are continuously reported by many teams all around the world and the aim of the present paper was to illustrate the clinical evidence registered up to now as well as to inform about the ongoing research efforts made to perform non visible scar surgery to treat more complex surgical diseases.

Laparoendoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) are emerging platforms to further reduce the invasive profile of surgery. As feasibility of an increasing array of procedures in both platforms is being demonstrated, with out comes comparable to multiport laparoscopy, there has been a parallel proliferation of concepts, terminology and technology. In this article, we describe the rationale behind the evolving paradigm shift towards truly "scarless" surgery and address the terminology associated with these surgical approaches.