title: Initial experience of umbilical laparoendoscopic single-site nephron-sparing surgery with KeyPort and DuoRotate system.
abstract: OBJECTIVE
  To present the feasibility of laparoendoscopic single-site (LESS) nephron-sparing surgery (NSS) using new reusable umbilical single-port system and instruments.
  
  
  METHODS
  A prospective study was performed to evaluate operative data and patient outcomes after LESS-NSS with KeyPort®, a tri-channel single-port placed through a 2.5-cm umbilical incision, and specific DuoRotate® instruments. Patient characteristics, operative time, estimated blood loss (EBL), complications, visual analog pain scale (VAPS), and visual analogue wound satisfaction scale (VAWSS) scores were registered.
  
  
  RESULTS
  Six consecutive nonselected patients with indication of NSS and normal contralateral kidney were offered LESS-NSS. An accessory 3.5 mm port that facilitated renoraphy and unclamped technique was used in 4 (66.7%) cases each. Median tumor maximum size was 4.0 (1-7.5) cm; age 64 (31-76) years; body mass index 28.4 (22.1-39.3) kg/m(2); operative time 233.5 (140-250) min; EBL 500 (200-500) mL; difference in hemoglobin 2.3 (0.1-4.6) g/dL. VAPS at day 2 was 0.7/10 and the median length of stay 3 (2-4) days. One case (16.7%) needed transfusion. None required conversion to standard laparoscopy or use of other additional ports. Postoperative complications occurred in 3 (50%) and major complications in 1 (16.7%). Incisions were totally hidden in the umbilicus. Pathology revealed angiomyolipoma (3), renal cell carcinoma (2), and chronic inflammation (1). Tumor margins were negative in all cases with malignancy. VAWSS at first month was 9.4 (8.1-10). At a median follow-up of 24 (10-32) weeks, no patient developed complications related to the approach.
  
  
  CONCLUSIONS
  Umbilical LESS-NSS through a new single-port system of reusable nature, with or without the help of an accessory port and occasionally without clamping, can be effectively and very economically performed with minimum postoperative pain. Good candidates are patients with presumed benign renal masses that appreciate the cosmetic advantage of the approach.
authors: Department of Urology, Foundation for Biomedical Research, University Hospital of Getafe, European University of Madrid, Madrid, Spain .
authors: Pedro M
authors: PM
authors: Cabrera
authors: Felipe
authors: F
authors: Cáceres
authors: Ana
authors: A
authors: García-Tello
authors: Javier C
authors: JC
authors: Angulo
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014472:Umbilicus