title: Low-cost reusable instrumentation for laparoendoscopic single-site nephrectomy: assessment in a porcine model.
abstract: OBJECTIVE
  To test different sets of prebent instruments and a new reusable access device for laparoendoscopic single-site (LESS) surgery.
  
  
  METHODS
  Three surgeons with previous experience in LESS performed 12 nephrectomies in six pigs. In all procedures, a multichannel access device (X-CONE) and a 5-mm extra-long telescope were used. Four sets of prebent instruments with different profiles (S-portal) were tested: Standard (one straight scissors and one curved grasper), Cuschieri, Carus, and Leroy set (each of them consisting of two curved instruments with different configurations). Assessment was performed based on both objective (procedure time; time to manage the pedicle; time to free kidney) and subjective parameters (entry/exit of instruments; triangulation; dissection up/down; dissection lateral; retraction; interdependence). The subjective assessment tool used was a Likert type scale (1 = easy to 5 = prohibitive). The access device was assessed by using objective (time to complete insertion of device after skin incision) and subjective (significant air leakage, movement constraint) parameters.
  
  
  RESULTS
  Time to insertion of the X-CONE was <1 minute in all the cases. Surgeons reported significant insufflant leakage in 58% of cases. The procedure was completed in 10/12 (83%) cases. Mean operative time was 8.3 ± 4.2 minutes, being lower for the Carus group (4.5 min) and higher for the standard group (13 min). Among the different sets, the standard one obtained the best mean scores for all subjective parameters.
  
  
  CONCLUSIONS
  X-CONE allows easy abdominal access, and its reusable properties represent cost savings for LESS compared with disposable devices. Prebent instruments might also represent attractive low-cost tools for LESS.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44194, USA. autorir@ccf.orgricautor@tin.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Kim
authors.forename: Abhay
authors.initials: A
authors.lastname: Rane
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Jorge
authors.initials: J
authors.lastname: Correia-Pinto
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Estevão
authors.initials: E
authors.lastname: Lima
mesh_terms: D000818:Animals; D003362:Cost-Benefit Analysis; D017743:Equipment Reuse; D020706:Laparoscopes / Q000191:economics*; D023421:Models, Animal; D009392:Nephrectomy / Q000191:economics* / Q000295:instrumentation*; D034421:Sus scrofa / Q000601:surgery*