title: Portless endoscopic radical nephrectomy via a single minimum incision in 80 patients.
abstract: OBJECTIVE
  To assess the feasibility of our portless endoscopic radical nephrectomy via a single minimum incision, which narrowly permitted extraction of the specimen in the initial 80 patients.
  
  
  METHODS
  Radical nephrectomy was carried out extraperitoneally in patients with T1-3aN0M0 renal tumors using an endoscope through a single minimum incision without trocar ports and gas. All the instruments used were reusable.
  
  
  RESULTS
  The average length of incision, operative time and estimated blood loss were 6.6 cm (range, 4-9 cm), 3. 1 h (range, 1.7-5.6 h) and 324 mL (range, 10-2288 mL), respectively. The complication rate was 2.5% (2/80); complications included injury of the pleura and hemorrhage from the vena cava, both of which were repaired by suture during operation. Transfusion was performed in three patients (3.8%). Average times to oral feeding and walking were both 1.4 days. Wound pain was minimal and analgesics were generally not required by the second postoperative day. In patients with larger incisions (7 cm or more), estimated blood loss increased (approximately 100 mL on average) and oral feeding resumed later (0.3 days on average), relative to patients with smaller incisions (6 cm or less). However, overall results were similar between the two patient groups. In patients with a large tumor (7 cm or greater), operative time did not increase and complications and transfusions were both avoided.
  
  
  CONCLUSIONS
  Portless endoscopic radical nephrectomy via a single minimum incision is a safe, reproducible, cost-effective and minimally invasive treatment option for patients with T1-3aN0M0 renal tumors.
authors.affiliation: Department of Urology and Reproductive Medicine Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. k-kihara.uro@tmd.ac.jp
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kageyama
authors.forename: Masataka
authors.initials: M
authors.lastname: Yano
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Hyochi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome