title: Laparoendoscopic single-site nephrectomy using a modified umbilical incision and a home-made transumbilical port.
abstract: OBJECTIVE
  To assess the clinical utility of laparoendoscopic single-site surgery (LESS) nephrectomy using a modified umbilical incision and home-made transumbilical port in cases requiring extirpative surgery.
  
  
  METHODS
  Initial consecutive 18 patients underwent LESS nephrectomies that were performed by a single surgeon. A home-made port was placed through a modified umbilical incision, the length of which had preoperatively been determined. The laparoscopic transperitoneal nephrectomy procedures were performed with various combinations of standard and articulating laparoscopic instruments. Patient characteristics and perioperative outcomes, including pathologic results, were recorded prospectively.
  
  
  RESULTS
  All 18 extirpative surgeries, including simple nephrectomy (eight cases), radical nephrectomy (nine cases), and nephroureterectomy (one case), were completed successfully. The median operation time was 167 min (range 82-220), and the median blood loss was 250 mL (range 0-1050). All specimens were extracted intact through a modified umbilical incision (median length 2.5 cm, range 1.5-6.0). Final pathological analysis revealed a nonfunctioning kidney in five cases, a dysplastic kidney in three cases, a mixed epithelial and stromal tumor in one case, renal cell carcinoma in eight cases (T1: five cases, T3: three cases), and Ta ureter transitional cell carcinoma in one case.
  
  
  CONCLUSIONS
  LESS nephrectomy using a home-made port and modified umbilical incision is feasible with both minimal incision and cost-effective. Our technique may be more useful for extirpative procedures in which a specimen needs to be removed intact, because incision length can be freely adjusted. Prospective comparisons are warranted to more clearly elucidate the utility of this surgical technique.
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 102-752, Korea.
authors.forename: Ho Song
authors.initials: HS
authors.lastname: Yu
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Ham
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D011182:Postoperative Care; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery