OBJECTIVES: Natural
orifice transluminal
endoscopic surgery comprises intraabdominal
surgery performed by way of natural
orifices (ie,
vagina,
mouth). In a similar manner, the umbilicus provides an
embryonic natural
orifice that permits intraabdominal access. We report on the feasibility of performing single-port advanced laparoscopic
reconstructive surgery by way of the umbilicus in 6 patients. We propose the terminology embryonic-natural
orifice transluminal
endoscopic surgery (E-NOTES) for this novel
surgical approach. METHODS: Through a single 1.5- to 3-cm intraumbilical incision and a novel, single-access port, we performed laparoscopic bilateral single-session Anderson-Hynes pyeloplasty (2 patients, 4 procedures), ileal
ureter (n = 1), and ureteroneocystostomy with a psoas hitch (n = 1). No extraumbilical
skin incisions were used. A 2-mm Veress needle port, inserted through a
skin needle puncture, was used to create the
pneumoperitoneum and to selectively insert a needlescopic grasper to assist in suturing. RESULTS: All procedures were successful without the need for any additional laparoscopic ports. For the 2 patients undergoing bilateral pyeloplasty (including patient repositioning) and the 1 patient each undergoing ileal
ureter and psoas-hitch ureteroneocystostomy, the operating time was 4.5, 6, 5, and 3 hours,
blood loss was 100, 50, 75, and 50 mL, and the hospital stay was 1, 2, 3, and 2 days, respectively. No intraoperative or postoperative complications developed. CONCLUSIONS: To our knowledge, we present the initial experience with advanced laparoscopic reconstruction through a single intraumbilical port. Additional refinement of this technology could lead to wider incorporation of single-port laparoscopy in clinical practice. Embryonic-natural
orifice transluminal
endoscopic surgery appears to be a promising
new approach for select indications.
