Notes
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The document discusses natural orifice transluminal endoscopic surgery (NOTES) in urology, highlighting its advantages like reduced incisions and quicker recovery, while also addressing concerns about infection and technical complexity. It reviews various access methods such as trans-vaginal, trans-gastric, and trans-colonic, weighing their benefits and drawbacks. The text includes references to experimental studies, emerging technologies, and the necessity for further development and clinical registry inclusion for safe implementation in minimally invasive surgery.
![BJU Int. 2008 Jan;101(1):83-8 . Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. Desai MM, Kaouk JH , Gill IS et al J Endourol. 2008 Aug;22(8):1573-6 . Single port access adrenalectomy. Castelucci SA, Harmon JD et al J Urol. 2008 Aug;180(2):637-41 ; Single port transumbilical (E-NOTES) donor nephrectomy. Gill IS, Kaouk JH, Desai MM Urology. 2008 Sep 15. [Epub ahead of print ] E mbryonic Natural Orifice Transumbilical Endoscopic Surgery (E-NOTES) for Advanced Reconstruction: Initial Experience. BJU Int. 2008 Sep 3. [Epub ahead of print ] Transumbilical single-port laparoscopic partial nephrectomy. Gill IS, Kaouk JH, Desai MM BJU Int. 2008 Sep 3. [Epub ahead of print ] Robotic single-port transumbilical surgery in humans: initial report. Kaouk JH, Goel RK, Haber GP, Crouzet S,Stein RJ.](https://image.slidesharecdn.com/notesanibalgoinia-110401080109-phpapp02/85/Notes-32-320.jpg)
Notes
- 1. NOTES Dr. Anibal W. Branco Curitiba – Pr VI CURSO TEORICO-PR Á TICO DE VIDEOLAPAROSCOPIA UROLOGICA DA UPF 25 a 28 de Setembro de 2008
- 2. O que é NOTES? N atural O rifice Oral, Anal, Vaginal, Uretral T rans-lumenal Através da parede de uma víscera oca Estômago, Colon/Reto, Bexiga, Vagina E ndoscopic Uso de endoscópio Rígido / Flexivel S urgery Dissecar, Remover, Suturar
- 3. Vantagens Menor Incisão Menos Dor Recuperação Pós-Op. mais rápida Menor infecção de parede Evitar hérnia incisional Menor íleo Menor aderências
- 4. Dúvidas Qual é o melhor acesso? Como manejar as contaminações? Como dissecar? Como reconstruir? Quem vai realizar: cirurgiões ou endoscopistas? Há vantagens significativas? Como se fará o treinamento? É seguro?
- 5. Dificuldades Acesso seguro Retração Ligadura Triangulação Liberdade de movimento e Triangulação Visualização (Visão de cabeça p/ baixo) Fechamento seguro Aceitação
- 6. Desvantagens Infecção Abdominal Fístulas Tecnicamente Complexo Avanço Tecnológico T. Cir. Prolongado Curva de Aprendizado Custo
- 7. Orifícios Naturais Trans-Vaginal Trans-Gastrico Trans-Colônico Trans-Uretral Combinada
- 8. Trans-Vaginal Vantagens Sem risco de fístula Linha reta p/ abdome superior Instrumentos Rígidos Fácil fechamento Desavantagens Somente em mulheres Retro-flexão para pelve Aceitação da paciente
- 12. Trans-Gástrico Vantagens Linha reta p/pelve Abordagem Universal Acesso seguro p/ abdome(Fígado) Aceitação do Paciente Desvantagens - Dificuldade de fechamento - Risco de Fístula - Retro-flexão p/abdome superior - Ácido - Limitado tamanho p/ extração do espécime
- 15. Trans-Colônico Vantagens - Linha reta p/ abdome superior - Instrumentos Rígidos - Orifício Universal - Tamanho do Espécime Desvantagens - Alto risco de fístula - Aceitação do Paciente -Preparo Intestinal
- 16. Trans-Vesical Vantagens - Linha reta p/ abdome superior - I nstrumentos rígidos - Orifício Universal - Baixo risco de fístula - Fácil acesso Desvantagens - Aceitação do Paciente -Limitado tamnho p/ extração do espécime
- 17. Trans-Vesical Lima E, Rolanda C, Pego J, et al. Transvesical endoscopic peritoneoscopy: a novel 5mm port for intra-abdominal scarless surgery. J Urol 2006;176:802–5.
- 18. Technology Suturing Transporter (G-Prox) Eagle Claw T Tags Shape Lock Cobra New Scopes R-Scope Endo-Therapeutic Operation Device Neo Guide
- 20. COBRA
- 21. Transport
- 22. Experimental Notes in Urology - Gettman MT, Lotan Y, Napper CA, Cadeddu JA. Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 2002;59:446-50 -Clayman RV, Box GN, Abraham JB, et al. Rapid communication:Transvaginal single-port NOTES nephrectomy: initial laboratory experience. J Endourol 2007;21:640–4 .
- 23. Experimental Notes in Urology Lima E, Rolanda C, Pego J, et al. Third-generation nephrectomy by natural orifice transluminal endoscopic surgery. J Urol 2007;178:2648–54 . Justin P. Isariyawongse, Lee E. Ponsky Pure Natural Orifice Transluminal Endoscopic Surgery (NOTES) Nephrectomy Using Standard Laparoscopic Instruments in the Porcine Model Journal of Endourology. May 2008, 22(5): 1087-1092
- 25. Geoffrey N. Box, Hak J. Lee, Ricardo J.S. Santos, Jose Benito A. Abraham, Michael K. Louie, Aldrin Joseph R. Gamboa, Reza Alipanah, Leslie A. Deane, Elspeth M. McDougall, Ralph V. Clayman . Rapid communication : Robot-Assisted NOTES Nephrectomy: Initial Report Journal of Endourology. March 1, 2008, 22(3): 503-506 Georges-Pascal Haber, Sebastien Crouzet, Kazumi Kamoi, Andre Berger, Monish Aron, Raj Goel, David Canes, Mihir Desai, Inderbir S. Gill, Jihad H. Kaouk Rapid communication: Robotic NOTES(Natural Orifice Translumenal Endoscopic Surgery) in Reconstructive Urology: Initial Laboratory Experience Urology. June 2008, Vol. 71, Issue 6, Pages 996-1000
- 29. ...that pure NOTES should be further developed as a research topic in urology before widespread clinical implementation. The single small abdominal incision techniques are immediately available for careful clinical implementation and as such require immediate inclusion in a clinical registry to determine their proper role in minimally invasive urologic surgery.
- 32. BJU Int. 2008 Jan;101(1):83-8 . Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. Desai MM, Kaouk JH , Gill IS et al J Endourol. 2008 Aug;22(8):1573-6 . Single port access adrenalectomy. Castelucci SA, Harmon JD et al J Urol. 2008 Aug;180(2):637-41 ; Single port transumbilical (E-NOTES) donor nephrectomy. Gill IS, Kaouk JH, Desai MM Urology. 2008 Sep 15. [Epub ahead of print ] E mbryonic Natural Orifice Transumbilical Endoscopic Surgery (E-NOTES) for Advanced Reconstruction: Initial Experience. BJU Int. 2008 Sep 3. [Epub ahead of print ] Transumbilical single-port laparoscopic partial nephrectomy. Gill IS, Kaouk JH, Desai MM BJU Int. 2008 Sep 3. [Epub ahead of print ] Robotic single-port transumbilical surgery in humans: initial report. Kaouk JH, Goel RK, Haber GP, Crouzet S,Stein RJ.
- 36. 2002 Reddy & Rao Appendectomy Feb 2006 Ponsky Exploration Marks PEG Rescue Bessler Trans-Vaginal Cholecystectomy Marescaux Swanstrom Trans-Gastric Cholecystectomy Dec 2006 Mar 2007 Apr 2007 Jun 2007 Aug 2007 Branco A.W. Hybrid T.V. Nephrectomy Zornig Talamini Rigid retracction Human NOTES Galvao: TV Chole, Hysterectomy Oct 2007
- 37. ?