title: Single institution experience with robot-assisted laparoendoscopic single-site renal procedures.
abstract: OBJECTIVE
  The desire to decrease morbidity from multiple port sites and progress toward a natural orifice approach has stimulated interest in laparoendoscopic single-site (LESS) surgery. Limitations, however, including clashing of instruments and loss of triangulation, have prevented widespread dissemination of LESS. To overcome these problems, the advantages of the robotic platform have been applied to single-site surgery. The objective of this article is to review our experience and summarize the current literature pertaining to robot-assisted LESS renal surgery.
  
  
  METHODS
  Twenty-eight robot-assisted LESS kidney procedures were identified from our prospectively maintained LESS database. These included 11 radical nephrectomies, 5 partial nephrectomies, 3 nephroureterectomies, 7 pyeloplasties, 1 simple nephrectomy, and 1 renal cyst decortication. Perioperative and postoperative data were analyzed.
  
  
  RESULTS
  Of 28 cases, 4 conversions occurred. The remaining procedures were performed with no extraincisional trocars. Mean follow-up was 11.3 months for radical nephrectomy, 21.3 months for partial nephrectomy, 17.8 months for nephroureterectomy, 12.9 months for pyeloplasty, 4 months for simple nephrectomy, and 1.6 months for renal cyst decortication. Patients who underwent radical nephrectomy, partial nephrectomy, and nephroureterectomy all had negative surgical margins and have remained disease free during the follow-up period. Six of seven patients who underwent pyeloplasty reported complete resolution of symptoms while the seventh reports significant improvement.
  
  
  CONCLUSIONS
  We present a large experience with robot-assisted LESS kidney surgery demonstrating the wide variety of procedures that can be performed. Further follow-up of this patient population is needed to document continued oncologic efficacy and durability of results.
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland, OH 44195, USA. khannara@upstate.edu
authors.forename: Rakesh
authors.initials: R
authors.lastname: Khanna
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
authors.forename: Wahib
authors.initials: W
authors.lastname: Isac
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
authors.forename: Gregory
authors.initials: G
authors.lastname: Spana
authors.forename: Gaurang
authors.initials: G
authors.lastname: Shah
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D019990:Perioperative Care; D019651:Plastic Surgery Procedures; D012371:Robotics / Q000379:methods*; D014513:Ureter / Q000601:surgery