Laparoendoscopic single-site (LESS) partial nephrectomy short-term outcomes.
OBJECTIVE
To present our experience of transumbilical laparoendoscopic single-site (LESS) partial nephrectomy (PN) with pathological and short-term oncological and renal functional outcomes.


METHODS
In all, 15 LESS-PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon. All patients underwent transumbilical LESS using a 5-mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments. The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN. Demographic, perioperative, and postoperative variables were recorded and analysed.


RESULTS
Of the 14 patients (eight men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2-4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins. The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0-37) min; bull-dog clamps were used for hilar-control in nine cases with the remaining six cases done without hilar vascular clamping. The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions. The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg. Follow-up surveillance imaging showed no recurrence at a mean (sd, range) follow-up of 18.3 (12.2; 6-36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow-up of 17.1 (11.9; 1-36) months.


CONCLUSIONS
LESS-PN is a feasible and effective operation, providing complete oncological resection along with excellent short-term oncological and renal functional outcomes.
The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA. soroushraisbahrami@gmail.com
Soroush
S
Rais-Bahrami
Arvin K
AK
George
Sylvia
S
Montag
Zhamshid
Z
Okhunov
Lee
L
Richstone
D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D016896:Treatment Outcome; D047368:Tumor Burden; D052096:Warm Ischemia