Laparoendoscopic single-site surgery: early experience with tumor nephrectomy.
OBJECTIVE
Laparoendoscopic single-site surgery (LESS) represents the closest surgical technique to scar-free surgery. We performed LESS for renal tumor nephrectomy in eight patients to assess feasibility and perioperative outcome.


METHODS
Eight patients with a body mass index (BMI) <or=30 underwent single-port nephrectomy for renal tumor by an experienced laparoscopic surgeon. Tri-Ports were used through a transumbilical incision in all cases. A flexible grasper and a 5-mm 30-degree high-definition camera were used in addition to standard laparoscopic equipment. Patient demographics; operative details, including procedure duration, blood loss, and complications; and final pathology results were prospectively recorded. Postoperative evaluation of pain and use of analgesic medication were recorded.


RESULTS
All LESS nephrectomy operations were successfully accomplished without the need to convert to conventional laparoscopy. The median patient age was 60.75 years (range 22-76 years) and median BMI was 22.95 (range 18.2-26.1). The median operative duration was 141 minutes (range 120-180 min), and the median blood loss was 103 mL (range 50-150 mL). Histologic evaluation confirmed complete excision of an intact specimen. All cases revealed organ-confined T(1) renal-cell carcinoma (two right-sided and six left-sided, tumor diameter range 4-8 cm). A tumor with an adjacent simple renal cyst was excised in one patient. No intraoperative or postoperative complications occurred.


CONCLUSIONS
LESS was a feasible and safe approach in a selected group of patients (low BMI and stage tumor). LESS nephrectomy was made possible with the use of multi-instrument port and flexible instruments. The oncologic outcome was not compromised. Further evaluation of LESS surgery needs prospective, randomized studies.
Stolzenburg
Jens-Uwe
JU
Department of Urology, University of Leipzig, Leipzig, Germany.
Hellawell
Giles
G
Kallidonis
Panagiotis
P
Do
Minh
M
Haefner
Tim
T
Dietel
Anja
A
Liatsikos
Evangelos N
EN
D000328:Adult; D000368:Aged; D000698:Analgesia; D002921:Cicatrix / Q000150:complications; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010149:Postoperative Pain / Q000150:complications; D011182:Postoperative Care; D011187:Posture; D012077:Renal Artery / Q000601:surgery; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000601:surgery; D055815:Young Adult