Upper urinary tract laparoendoscopic single-site surgery based on a novel cost-effective reusable platform.
OBJECTIVE
Several disposable platforms have been introduced for laparoendoscopic single-site (LESS) surgery. Besides technical issues, cost is one of the main limiting factors for their widespread use. We present our experience with LESS surgery for kidney pathologies using the first completely reusable LESS platform.


METHODS
We performed LESS kidney procedures in 29 patients including nephrectomy (18), partial nephrectomy (3), pyeloplasty (4), and renal cyst ablation (4). All procedures were performed using a completely reusable single-port device (X-Cone) with a simplified combination of standard and prebent instruments. We obtained perioperative and demographic data including a visual analog pain scale (VAS); complications were recorded using Clavien grading.


RESULTS
Mean patient age was 49.31 years. Conversion to standard laparoscopy was necessary in one and addition of a needlescopic instrument in four cases. No open conversion was necessary. Intra- and postoperative complications occurred in two (Clavien II) cases. Mean operative time was 110, 90, and 89 minutes, and hospital stay was 4.9, 3.1, and 3.6 days for nephrectomy, partial nephrectomy, and pyeloplasty, respectively. Mean VAS was 2.13, 1.67, and 1.5 while blood loss was 81.3 mL, 140 mL, and 17.5 mL, respectively. There were no positive resection margins.


CONCLUSIONS
LESS with a completely reusable platform is feasible for different upper urinary tract procedures yielding favorable functional and cosmetic results. A simplified combination of standard straight instruments and a single prebent grasper facilitates handling and shortens the learning curve. Reusable materials significantly reduce cost and may help to further adopt LESS surgery in surgical practice.
Department of Urology, Eberhard-Karls University Tuebingen, Germany. christian.schwentner@med.uni-tuebingen.de
Christian
C
Schwentner
Tilman
T
Todenhöfer
Joerg
J
Seibold
Saladin H
SH
Alloussi
Stefan
S
Aufderklamm
Johannes
J
Mischinger
Miriam
M
Germann
Arnulf
A
Stenzl
Georgios
G
Gakis
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003710:Demography; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D014472:Umbilicus / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult