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Urological applications of natural orifice transluminal endoscopic surgery (NOTES)

机译：天然孔腔内镜手术（NOTES）的泌尿外科应用

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Improvements in surgical techniques, and particularly the development and widespread clinical introduction of laparoscopy in the past two decades, have revolutionized the management of urological disease. Natural orifice transluminal endoscopic surgery (NOTES) holds promise in further advancing treatment outcomes in urology. This novel minimally invasive surgical approach can negate the requirement for skin incisions and, therefore, could potentially improve morbidity, convalescence, and cosmesis. After considerable preclinical development, the feasibility of 'hybrid' NOTES - involving concurrent laparoscopy - and 'pure' NOTES nephrectomy and prostatectomy procedures has now been successfully demonstrated in patients with urological conditions, whereas proof-of-concept studies of NOTES partial cystectomy have been performed in animal models. Whether such procedures offer therapeutic and safety benefits compared with traditional laparoscopic techniques remains unknown; indeed, concerns remain over the potential perioperative and postoperative adverse events associated with NOTES, such as incomplete closure of the entry-point incision, infection, and haemorrhage. In particular, however, the requirement for the development of specific rationally designed NOTES instrumentation as well as specially trained, highly skilled personnel to perform the surgery continues to restrict the utility of NOTES. Thus, considerable effort is now needed to shift the focus of research to refining NOTES methodologies to enable translation of these promising proof-of-principle studies into the clinic.
机译：外科技术的进步，尤其是过去二十年来腹腔镜的发展和广泛的临床应用，彻底改变了泌尿科疾病的管理方法。天然孔腔内镜手术（NOTES）有望进一步提高泌尿外科治疗的效果。这种新颖的微创手术方法可以消除皮肤切口的需要，因此可以潜在地改善发病率，康复和美容效果。经过大量的临床前开发，“混合型” NOTES（包括同时进行的腹腔镜检查）和“纯” NOTES肾切除术和前列腺切除术的可行性现已在泌尿系统疾病患者中得到了成功证明，而NOTES部分膀胱切除术的概念验证研究已经得到了证实。在动物模型中执行。与传统的腹腔镜技术相比，这种方法是否具有治疗和安全性的益处尚不清楚;实际上，仍然存在与NOTES相关的潜在的围手术期和术后不良事件，例如切开切口的闭合不完全，感染和出血等问题。但是，特别是，对开发特定的合理设计的NOTES仪器以及经过专门培训的高技能人员进行手术的要求继续限制了NOTES的实用性。因此，现在需要付出很大的努力才能将研究重点转移到完善NOTES方法上，以将这些有前途的原理验证研究转化为临床应用。

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