title: Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: outcomes of an international multi-institutional study of 101 patients.
abstract: OBJECTIVE
  To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU).
  
  
  METHODS
  Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed.
  
  
  RESULTS
  The study included 101 patients whose mean (SD) age was 66.4 (9.9) years and mean (SD) body mass index was 24.8 (4) kg/m², and of whom 29.7% had undergone previous abdominal/pelvic surgery. The mean (SD) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9%). The mean (SD) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months.
  
  
  CONCLUSIONS
  This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.
authors.affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Sung Yul
authors.initials: SY
authors.lastname: Park
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Ithaar
authors.initials: I
authors.lastname: Derweesh
authors.forename: Evangelos
authors.initials: E
authors.lastname: Liastikos
authors.forename: Yao Chou
authors.initials: YC
authors.lastname: Tsai
authors.forename: Ill Young
authors.initials: IY
authors.lastname: Seo
authors.forename: Ugo
authors.initials: U
authors.lastname: Nagele
authors.forename: Aly M
authors.initials: AM
authors.lastname: Abdel-Karim
authors.forename: Thomas
authors.initials: T
authors.lastname: Herrmann
authors.forename: Deok Hyun
authors.initials: DH
authors.lastname: Han
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.forename: Seung Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Kyu Shik
authors.initials: KS
authors.lastname: Kim
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.forename: Christopher
authors.initials: C
authors.lastname: Springer
authors.forename: Salah
authors.initials: S
authors.lastname: Élsalmy
authors.forename: Shih-Chieh Jeff
authors.initials: SC
authors.lastname: Chueh
authors.forename: Chen-Hsun
authors.initials: CH
authors.lastname: Ho
authors.forename: Kamol
authors.initials: K
authors.lastname: Panumatrassamee
authors.forename: Ryan
authors.initials: R
authors.lastname: Kopp
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Chung
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Shin
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D012371:Robotics; D016019:Survival Analysis; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: LESS; laparoendoscopic single-site surgery; multi-institutional; transitional cell carcinoma