Es la cirugía less o notes el nuevo “gold standard” de la cirugía mínimamente invasiva? / Is LESS/NOTES surgery the new gold standard of minimally invasive surgery?

RESUMEN

En los últimos 20 años la cirugía ha sufrido un cambio espectacular. Hemos visto como la cirugía abierta era prácticamente sustituida por la laparoscopia y ésta ha evolucionado hacia cirugías mínimamente invasivas como la cirugía a través de una única incisión (Laparo Endoscopic Single-site Surgery, LESS) y la cirugía a través de orificios naturales (Natural Orifice Transluminal Endoscopic Surgery, NOTES). Estas cirugías mínimamente invasivas pretenden reducir al máximo el tamaño y número de cicatrices abdominales para minimizar la morbilidad, reduciendo la agresión y por lo tanto la necesidad de analgesia en el postoperatorio, y ofreciendo unos excelentes resultados estéticos. La cirugía LESS implica la realización de cirugía intra-abdominal a través de una única incisión de 3-4 cm, por la cual se introducen instrumentos laparoscópicos. Esta puede ser considerada como el siguiente paso en la evolución de la cirugía laparoscópica avanzando hacia el ideal de cirugía sin cicatriz. Esta modalidad está teniendo una gran aceptación, ya que permite la introducción de un trocar extra en cualquier momento transformándola en cirugía laparoscopia convencional. Además, al realizar la incisión a nivel umbilical permite camuflar la incisión en el propio ombligo al finalizar la cirugía, consiguiendo muy buenos resultados estéticos(AU)

ABSTRACT

Over the last 20 years surgery has suffered a dramatic change. We saw how open surgery was almost replaced by laparoscopic surgery and this latter has evolved to minimally invasive surgical techniques such as Laparo Endoscopic Single-site Surgery (LESS) and NOTES ((Natural Orifice Transluminal Endoscopic Surgery). These minimally invasive operations try to maximally reduce the size and number of abdominal scars in order to minimize morbidity, reducing surgical aggression and therefore the need for analgesia during the postoperative period, and they offer excellent cosmetic results. LESS surgery implies the performance of intra-abdominal surgery through a single 3-4 cm incision, through which laparoscopic instruments are introduced. This may be considered the next step in the evolution of laparoscopic surgery advancing to the ideal of scarless surgery. This modality is having great acceptance, since it allows the insertion of an extra trocar at any time transforming it in conventional laparoscopic surgery. Furthermore, when performing the incision within the umbilical scar, it enables concealing the incision in it at the end of the operation, achieving very good cosmetic results. NOTES surgery would be another step forward. Pure NOTES techniques in the field of Urology are very complex to perform today with the available equipment. Hybrid NOTES and assisted NOTES are variations described which have demonstrated they are viable and offer very good cosmetic results and lower morbidity. Regarding this, the vaginal approach offers a good working channel that can also be used for specimen extraction. Recent published studies confirm the feasibility and reproducibility of both techniques in urologic surgery, specifically in the treatment of renal cancer, with comparable results to conventional laparoscopic surgery(AU)