Smith Blog

In 1953, John Hunt led a British expedition to climb Mount Everest that unfortunately had to turn around within 300 feet of the summit.  Although the group failed its task, they defined a route and introduced a technique for carrying extra oxygen that allowed the New Zealander Edmund Hillary to reach the summit a few days later. Hillary became Sir Hillary and the accomplishment was celebrated around the globe.

Several steps have been taken in the climb towards a true Natural Orifice Transluminal Endoscopic Surgery (NOTES) nephrectomy. This means removing organs through a natural orifice such as the mouth, rectum, urethra or vagina.  Previous reports demonstrate that kidney removal through the vaginal vault is feasible.

Is NOTES the summit of “Everest” or is it Base Camp? The answer is both. NOTES has fulfilled the dream of eliminating a visable incision for extirpative renal surgery. However, there are growing series of Laparoendoscopic Single-Site Surgery (LESS) nephrectomies that have shown only cosmesis as the advantage to minimizing the incision. Until a series of NOTES nephrectomies is evaluated it is uncertain whether there will be any additional benefit to the patient. The major issues of surgery still remain with postoperative ileus, fatigue and discomfort coming from the actual renal dissection which does not change based on location of trocar placement.

This kind of surgical exploration needs to be supported.  However, the real surgical “Everest” will be a quantum leap, a total replacement of our current notion of invasive extirpative surgery.  We should never take our eyes off this ultimate prize.

Louis R. Kavoussi, M.D.
Professor and Chairman
Smith Institute for Urology
Hofstra School of Medicine
North Shore-LIJ Health System
Long Island, NY