Hundreds of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) cases have been reported in the literature across a broad span of urological procedures. Despite this, many hurdles to widespread adoption of these techniques exist, including technical challenges, such as decreased triangulation and unfamiliar viewing angles, and more philosophical issues, such as the necessity of demonstrating benefits of these techniques over conventional laparoscopy. Future research will seek to overcome these obstacles. This may be accomplished with further instrument development, including robotic instrumentation, as well as clinical studies evaluating outcomes of LESS/NOTES operations that may demonstrate advantages in these techniques.
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