Pure single-port laparoscopic surgery or mix of techniques?
OBJECTIVE
Laparoendoscopic single-site surgery (LESS) has emerged in the recent years as an alternative approach to conventional laparoscopic surgery which is accompanied by additional advantages over laparoscopy. In this work we attempt to review the current literature and to investigate the possible combination of LESS to other currently available approaches such as natural orifice transluminal endoscopic surgery (NOTES), needlescopic and robotic laparoscopic surgery.


METHODS
Extensive literature search on the topics of LESS, hybrid and pure NOTES, Needlescopic-assisted LESS and "Robot-assisted LESS" took place. Additionally, the accumulated experience from 118 LESSs performed in our departments is presented in an attempt to provide evidence regarding the mix of technique in LESS in urology.


RESULTS
The challenging nature of LESS limits the broader application and acceptance. Expanding experience in single-site surgery has currently provided tools such as transvaginal access, needlescopic instruments and robot assistance that can aid LESS and enhance its efficiency without compromising any of its advantages. A mix of these techniques with LESS could ease the stiff learning curve of the second and benefit not only its performance but also the adaptation of LESS as a standard practice.


CONCLUSIONS
Pure LESS although feasible, remains a technical challenge for the surgeon, preventing the widespread application of the technique. The goal of urologists on LESS surgery should not be the purity of LESS approach, but the superiority against already established techniques. A mix of techniques could be a key for the documentation of the advantages of LESS over conventional laparoscopy.
Department of Urology, University of Patras Medical School, Rion, 26 500 Patras, Greece. liatsikos@yahoo.com
Evangelos
E
Liatsikos
Iason
I
Kyriazis
Panagiotis
P
Kallidonis
Minh
M
Do
Anja
A
Dietel
Jens-Uwe
JU
Stolzenburg
D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D012371:Robotics / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000639:trends