title: Laparoendoscopic single-site partial nephrectomy without ischemia for very small, exophytic renal masses: surgical details and functional outcomes.
abstract: BACKGROUND
  Laparoendoscopic single-site surgery (LESS) has emerged as a natural progression from standard laparoscopy aiming to further minimize the morbidity of urologic procedures.
  
  
  OBJECTIVE
  To describe our technique and report the surgical and functional outcomes of unclamped LESS partial nephrectomy (PN) in the treatment of small renal masses (SRMs).
  
  
  METHODS
  Prospective evaluation of pre- and postoperative variables of patients undergoing the LESS-PN without ischemia between 2009 and 2012. The indications were single exophytic SRMs.
  
  
  METHODS
  Unclamped LESS-PN was performed through a transperitoneal approach. A pararectal Hasson access technique was preferred. Single-port access was achieved via different single-port devices. A combination of straight and articulating laparoscopic instruments was used. The tumor was excised using bipolar scissors during normal renal perfusion. Hemostasis was achieved by bipolar electrocautery, parenchymal stitches, and hemostatic agents.
  
  
  METHODS
  Demographic, operative, postoperative, and pathologic outcomes data were recorded and analyzed.
  
  
  CONCLUSIONS
  A total of 21 LESS-PN were performed (operative time: 111 ± 41 min; blood loss: 196 ± 195 ml: tumor size: 2.0 ± 0.3 cm). Neither conversion to open surgery nor transfusions occurred. Three patients required conversion to standard laparoscopy. Postoperatively, three complications (Clavien grades 2, 3a, and 4) were recorded. Pathologic examination revealed 14 clear cell carcinomas, four renal cysts, two oncocytomas, and one angiomyolipoma. Hospital stay was 4.4 ± 1.9 d. At the last follow-up (mean: 17±11.5 mo), no port-site, local, or distant recurrences were detected. No significant variation in serum creatinine and estimated glomerular filtration rate was observed. Subjective scar evaluation indicated 66% of patients were very satisfied/enthusiastic. Study limitations include the small sample size, the lack of a control group, the short follow-up period, and the arbitrary measure of patient's scar perception.
  
  
  CONCLUSIONS
  Unclamped LESS-PN for selected SRMs is a safe and feasible procedure providing favorable postoperative outcomes and ensuring high levels of subjective, cosmetic satisfaction.
authors.affiliation: "S. Pio da Pietrelcina" Hospital, Department of Urology, Vasto (CH), Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Francesco
authors.initials: F
authors.lastname: Berardinelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Neri
authors.forename: Fabiola Raffaella
authors.initials: FR
authors.lastname: Tamburro
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007668:Kidney / Q000473:pathology* / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome