Consensus statement of the consortium for laparoendoscopic single-site surgery

Gill, Inderbir S.; Advincula, Arnold P.; Aron, Monish; Caddedu, Jeffrey A.; Canes, David; Curcillo, Paul G.; Desai, Mihir; Evanko, John C.; Falcone, Tommaso; Fazio, Victor W.; Gettman, Matthew T.; Gumbs, Andrew A.; Haber, Georges Pascal; Kaouk, Jihad; Kim, Fernando; King, Stephanie; Ponsky, Jeffrey L.; Remzi, Feza H.; Rivas, Homero; Rosemurgy, Alexander S.; Ross, Sharona; Schauer, Philip R.; Sotelo, René; Speranza, Jose; Sweeney, John F.; Teixeira, Júlio

doi:10.1007/s00464-009-0688-8

Cited by 265 publications

(169 citation statements)

References 7 publications

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“…Unfortunately, the quality of evidence of all available studies remains low, mostly being small case series [61][62][63] (evidence level 4) or case-control studies from selected centers [64][65][66][67][68][69][70][71] (evidence level 3b). Given the limited amount of data, available reviews are narrative [11,13,14,[29][30][31]78,79] or are based on expert opinions and consensus meetings [1,2,80] (evidence level 4). Thus far, the advantages of LESS still exist at a theoretical level, because no clear benefit on postoperative course and patient convalescence has been definitively proven.…”

Section: 4mentioning

confidence: 99%

“…In the meanwhile, it should be recommended that, together with proper patient selection, a surgeon possess adequate laparoscopic experience and preferably a certain amount of LESS training before embarking on a LESS procedure [80]. This is of utmost importance for minimizing serious complications, such as those seen in early reported series.…”

Section: 4mentioning

confidence: 99%

“…The Laparo-Endoscopic Single-Site Surgery Consortium for Assessment and Research consortium recommended that before a LESS procedure is performed, the surgeon should possess adequate standard laparoscopic experience and preferably should have undergone specific LESS surgical training, including a stepwise, structured program incorporating inanimate training models, hands-on animal training, observation of clinical procedures, and performance of initial LESS procedures in a mentored and proctored setting [80,94].…”

Section: Lowmentioning

confidence: 99%

“…Sensitivity to the potential for complications is critical, and the threshold for conversion to standard laparoscopy, or even open surgery, must be appropriately low. Disease features (ie, locally advanced disease requires more extensive dissection; abnormal anatomy requires extensive suturing) and patients features (ie, body habitus, BMI, comorbidity score, previous surgery or RT, personal preferences for better cosmetic outcome) are to be considered [80]. employed to scientifically verify these findings.…”

Section: Lowmentioning

confidence: 99%

“…Currently available validated tools, such as the SF-12 and SF-36 questionnaires, as well as the standard measures of postoperative morbidity, such as analgesic requirements, may be insufficiently sensitive to detect differences in patient outcomes between LESS and standard laparoscopy. These existing tools may need refinement, or newer tools might need to be developed [80]. Examining the efficacy and safety of new devices on the market and those under development represents a demanding task, and industry is expected to be much more responsive to the needs of urologic surgeons facing this task.…”

Section: Lowmentioning

confidence: 99%

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Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

et al. 2011

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LESS Natural orifice transluminal endoscopic surgery NOTES Robotics UrologyPlease visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery. Objective: To summarize and critically analyze the available evidence on the current status and future perspectives of LESS and NOTES in urology. Evidence acquisition: A comprehensive electronic literature search was conducted in June 2010 using the Medline database to identify all publications relating to NOTES and LESS in urology. Evidence synthesis: In urology, NOTES has been completed experimentally via transgastric, transvaginal, transcolonic, and transvesical routes. Initial clinical experience has shown that NOTES urologic surgery using currently available instruments is indeed possible. Nevertheless, because of the immaturity of the instrumentation, early cases have demanded high technical virtuosity. LESS can safely and effectively be performed in a variety of urologic settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low, mostly being small case series or casecontrol studies from selected centers. Thus, the only objective benefit of LESS remains the improved cosmetic outcome. Prospective, randomized studies are largely awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technology advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics is likely to drive a major paradigm shift in the development of LESS and NOTES. Conclusions: NOTES is still an investigational approach in urology. LESS has proven to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons. Development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.

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