Laparoendoscopic single-site partial nephrectomy without ischemia.
OBJECTIVE
Nephron-sparing surgery (NSS) ensures excellent oncologic and functional outcomes in small renal masses. Laparoendoscopic single-site surgery (LESS) is one of the major advances in the evolution of minimally invasive surgery. We describe our initial surgical experience and assess the feasibility of LESS unclamp-NSS.


METHODS
From April to September 2009, all consecutive patients with solitary, exophytic, enhancing, small (≤4.0 cm) renal masses and normal contralateral kidney were selected to receive LESS unclamp-NSS. A multichannel port provided intra-abdominal transperitoneal access. Rigid and articulable instruments were used for dissection, tumor exposure, and excision under normal renal perfusion. Perioperative, pathologic, hematologic data together with a subjective evaluation of pain and scar were collected and evaluated.


RESULTS
Six patients underwent LESS unclamp-NSS (mean operative time, 148 min; mean blood loss, 201 mL; mean renal masses size, 2.1cm). One patient needed conversion to standard laparoscopy because of excessive bleeding. Postoperatively, a cerebrovascular accident developed in one patient. No transfusion was necessary. Pathologic examination revealed two clear-cell carcinoma, three benign cysts, and one angiomyolipoma (surgical margin positive). A 2.7 g/dL hemoglobin level decrease was recorded with minimal pain and great patient satisfaction. Mean length of stay was 6 days.


CONCLUSIONS
LESS unclamp-NSS in selected renal masses is feasible, provides postoperative outcomes overlapping the standard counterpart, and ensures subjective satisfaction. Additional trocars should be considered for the hemostatic stitches and for liver retraction. A wider experience and longer follow-up are necessary to establish the role of this technique.
Cindolo
Luca
L
Urology Unit, S Pio da Pietrelcina Hospital, Vasto, CH, Italy. lucacindolo@virgilio.it
Berardinelli
Francesco
F
Gidaro
Stefano
S
Schips
Luigi
L
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D007668:Kidney / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000473:pathology / Q000601:surgery; D011182:Postoperative Care