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Radiation exposure to physicians' hands during interventional procedures with computed tomography (CT) fluoroscopic guidance may be high. A robot was developed that could hold, orient, and advance a needle, with CT fluoroscopic guidance. This robot could be either computer or joystick controlled. Twenty-three robotically guided percutaneous interventions were performed without complication. Physician radiation exposure was negligible during the CT fluoroscopy-guided procedures.

Medical treatment can be improved through integration and application of advances in technology, computers, and engineering. Accuracy and reliability are essential characteristics of any mechanical system, and with the evolution of machines capable of precise movements, the integration of medicine and machine is achievable. Early mechanical devices were effective in performing simple, repetitive tasks but were not sophisticated enough for independent function. In the automobile industry, robots could work on the assembly line executing these cyclic tasks. These machines could execute simple, reiterative movements without integrating new information from the environment. In this day and age, robots have evolved into sophisticated mechanical devices that can "react" to data detected in the environment to determine the next course of events. They have evolved from the assembly line to the operating room, assisting surgeons during surgery to participating in remote telesurgical procedures.

Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery. Context Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery. Objective To summarize and critically analyze the available evidence on the current status and future perspectives of LESS and NOTES in urology. Evidence acquisition A comprehensive electronic literature search was conducted in June 2010 using the Medline database to identify all publications relating to NOTES and LESS in urology. Evidence synthesis In urology, NOTES has been completed experimentally via transgastric, transvaginal, transcolonic, and transvesical routes. Initial clinical experience has shown that NOTES urologic surgery using currently available instruments is indeed possible. Nevertheless, because of the immaturity of the instrumentation, early cases have demanded high technical virtuosity. LESS can safely and effectively be performed in a variety of urologic settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low, mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains the improved cosmetic outcome. Prospective, randomized studies are largely awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technology advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics is likely to drive a major paradigm shift in the development of LESS and NOTES. Conclusions NOTES is still an investigational approach in urology. LESS has proven to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons. Development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.

Context: The gained expertise in the surgical technique of partial nephrectomy (PN) with excellent oncologic outcome and reduced morbidity has contributed to more frequent use of PN in many centres of reference, and the recent evidence favouring PN over radical nephrectomy (RN) in the prevention of chronic kidney disease and possibly linking it to a better overall survival (OS) will constitute a strong argument for wider use of PN. Objective: To objectively analyse the advantages of PN over RN and to evaluate the risk-benefit ratio of expanding the indications of PN T1b renal cortical tumours. Evidence acquisition: Literature searches on English-language publications were performed using the National Library of Medicine database. The queries included the keywords partial nephrectomy and nephron sparing surgery. Eight hundred four references were scrutinised, and 175 publications were identified and reviewed. Sixty-nine articles were selected for this review. These references formed the basis for this analysis and were selected based on their relevance and the importance of their content. Evidence synthesis: The use of PN has been steadily increasing, particularly in tertiary care centres. This trend is now strengthened by evidence supporting the role of PN in reducing the risk of chronic kidney disease in patients with renal masses 4 cm, PN obtained equivalent oncologic outcome to that achieved after RN. Although higher morbidity rates were seen after PN, the complication type and severity were not prohibitive. Conclusions: The available evidence supports elective PN as the standard surgical treatment for renal cortical tumours