Notes hybrid: the take-off of surgery through natural orifices in urology

Abstract

Objetives: the evolution of minimally invasive surgical therapies led to the development of NOTES surgery, (Natural Orifice Transluminal Endoscopic Surgery or surgery through natural orifices) has a purpose in implementing procedures by minimal trauma to the abdominal wall with the benefits that entails. We want to show our experience in urology with the application of NOTES and to disclose the potential benefits. Methods: it is a retrospective and descriptive study. We report the experience of natural orifice surgery for implementing hybrid NOTES technique in 3 cases with different pathologies, compromising the upper urinary tract. Using the first case, a multi-port through the umbilical scar and another through the vagina, and the other two cases with an umbilical and a multichannel obesityport of 12 mm through the vagina, both routes were used alternately in visualizing, dissecting and retracting tissues and for hilar control. Results: to date, three procedures have been carried out NOTES applying hybrid technology, of which two were radical nephrectomies for kidney cancer, and a third case undergone hemi-nephrectomy upper pole in a patient with double collecting system, and the excluded systemfunctionally superior. None required conversion to conventional laparoscopic technique; surgical times were similar to those used in conventional laparoscopic surgery. The hemi-nephrectomy case required reoperation for filing collection, urinoma. Conclusions: the combination of umbilical and transvaginal approach restores the principle of triangulation and facilitates the dissection. A greater experience and other studies that can assess reassurance, efficacy and reproducibility of the technique are necessary.