Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience

Area of Science:

• Minimally Invasive Surgery
• Urologic Surgery
• Surgical Innovation

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) utilizes natural orifices for intraabdominal access.
• The umbilicus, an embryonic natural orifice, offers potential for minimally invasive surgical entry.
• Advanced laparoscopic reconstructive surgery typically requires multiple abdominal incisions.

Purpose of the Study:

• To assess the feasibility of single-port advanced laparoscopic reconstructive surgery through the umbilicus.
• To introduce and evaluate a novel approach termed embryonic-natural orifice transluminal endoscopic surgery (E-NOTES).

Main Methods:

• Six patients underwent advanced laparoscopic reconstructive surgery via a single 1.5- to 3-cm intraumbilical incision.
• Procedures included bilateral Anderson-Hynes pyeloplasty, ileal ureter, and ureteroneocystostomy with psoas hitch.
• A novel single-access port and needlescopic instruments were utilized, avoiding extraumbilical incisions.

Main Results:

• All procedures were completed successfully using only the single umbilical port.
• Operating times ranged from 3 to 6 hours, with blood loss between 50 and 100 mL.
• Hospital stays varied from 1 to 3 days, with no intraoperative or postoperative complications reported.

Conclusions:

• Initial experience demonstrates the feasibility of advanced laparoscopic reconstruction via a single intraumbilical port.
• Embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) is a promising approach for specific surgical indications.
• Further refinement of this technique may expand the use of single-port laparoscopy in clinical practice.