title: Laparoendoscopic single-site partial nephrectomy: a multi-institutional outcome analysis.
abstract: BACKGROUND
  Laparoendoscopic single-site surgery (LESS) has been developed in an attempt to further reduce the surgical trauma associated with conventional laparoscopy. Partial nephrectomy (PN) represents a challenging indication for LESS.
  
  
  OBJECTIVE
  To report a large multi-institutional series of LESS-PN and to analyze the predictors of outcomes after LESS-PN.
  
  
  METHODS
  Consecutive cases of LESS-PN done between November 2007 and March 2012 at 11 participating institutions were included in this retrospective analysis.
  
  
  METHODS
  Each group performed LESS-PN according to its own protocols, entry criteria, and techniques.
  
  
  METHODS
  Demographic data, main perioperative outcome parameters, and perioperative complications were gathered and analyzed. A multivariable analysis was used to assess the factors predicting a short (≤ 20 min) warm ischemia time (WIT), the occurrence of postoperative complication of any grade, and a favorable outcome, arbitrarily defined as a combination of the following events: short WIT plus no perioperative complications plus negative surgical margins plus no conversion to open surgery or standard laparoscopy.
  
  
  CONCLUSIONS
  A total of 190 cases were included in this analysis. Mean renal tumor size was 2.6, and PADUA score 7.2. Median operative time was 170 min, with median estimated blood loss (EBL) of 150 ml. A clampless technique was adopted in 70 cases (36.8%), and the median WIT was 16.5 min. PADUA score independently predicted length of WIT (low vs high score: odds ratio [OR]: 5.11 [95% confidence interval (CI), 1.50-17.41]; p=0.009; intermediate vs high score: OR: 5.13 [95% CI, 1.56-16.88]; p=0.007). The overall postoperative complication rate was 14.7%. The adoption of a robotic LESS technique versus conventional LESS (OR: 20.92 [95% CI, 2.66-164.64]; p=0.003) and the occurrence of lower (≤ 250 ml) EBL (OR: 3.60 [95% CI, 1.35-9.56]; p=0.010) were found to be independent predictors of no postoperative complications of any grade. A favorable outcome was obtained in 83 cases (43.68%). On multivariate analysis, the only predictive factor of a favorable outcome was the PADUA score (low vs high score: OR: 4.99 [95% CI, 1.98-12.59]; p<0.001). Limitations of the study were the retrospective design and different selection criteria for the participating centers.
  
  
  CONCLUSIONS
  LESS-PN can be safely and effectively performed by experienced hands, given a high likelihood of a single additional port. Anatomic tumor characteristics as determined by the PADUA score are independent predictors of a favorable surgical outcome. Thus patients presenting tumors with low PADUA scores represent the best candidates for LESS-PN. The application of a robotic platform is likely to reduce the overall risk of postoperative complications.
authors: Department of Urology and Renal Transplantation, Martin-Luther-University, Halle/Saale, Germany. francesco.greco@medizin.uni-halle.de
authors: Francesco
authors: F
authors: Greco
authors: Riccardo
authors: R
authors: Autorino
authors: Koon H
authors: KH
authors: Rha
authors: Ithaar
authors: I
authors: Derweesh
authors: Luca
authors: L
authors: Cindolo
authors: Lee
authors: L
authors: Richstone
authors: Thomas R W
authors: TR
authors: Herrmann
authors: Evangelos
authors: E
authors: Liatsikos
authors: Yinghao
authors: Y
authors: Sun
authors: Caterina
authors: C
authors: Fanizza
authors: Udo
authors: U
authors: Nagele
authors: Jens-Uwe
authors: JU
authors: Stolzenburg
authors: Soroush
authors: S
authors: Rais-Bahrami
authors: Michael A
authors: MA
authors: Liss
authors: Luigi
authors: L
authors: Schips
authors: Ahmad
authors: A
authors: Kassab
authors: Linhui
authors: L
authors: Wang
authors: Panagiotis
authors: P
authors: Kallidonis
authors: Zhenjie
authors: Z
authors: Wu
authors: Shin Tae
authors: ST
authors: Young
authors: Nasreldin
authors: N
authors: Mohammed
authors: Georges-Pascal
authors: GP
authors: Haber
authors: Christopher
authors: C
authors: Springer
authors: Paolo
authors: P
authors: Fornara
authors: Jihad H
authors: JH
authors: Kaouk
mesh_terms: D001208:Asia; D005060:Europe; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D052096:Warm Ischemia
keywords: Complications; Laparoendoscopic single-site surgery; Partial nephrectomy; Warm ischemia time