Cost effective laparoendoscopic single-site surgery with a reusable platform.
OBJECTIVE
Many disposable platforms have been applied in laparoendoscopic single-site surgery (LESS). Besides technical issues, cost is one of the limiting factors for its widespread acceptance. The current study describes the first completely reusable LESS-platform.


METHODS
We performed LESS-procedures in 52 patients including nephrectomy (18), adrenalectomy (2), partial nephrectomy (3), pyeloplasty (4), renal cyst ablation (4), pelvic lymphadenectomy (15), and lymphocele ablation (6). All procedures were conducted using a novel reusable single-port device (X-Cone, Karl-Storz) with a simplified set of instruments. We obtained perioperative and demographic data, including a visual analogue pain scale (VAS), and a complication reporting system based on Clavien grading.


RESULTS
Mean age was 50.04 y. Conversion to standard laparoscopy was necessary in 3 cases and addition of a needlescopic instrument in 6 cases. There was no open conversion. Intra- and postoperative complications occurred in 3 (Clavien II in 2 and III in 1) cases. Mean operative time was 110, 90, and 89 min, and hospital stay was 4.9, 3.1, and 3.6 d for nephrectomy, pelvic lymphadenectomy, and pyeloplasty, respectively. Mean VAS was 2.13, 1.07, and 1.5 while blood loss was 81.3 mL, 25.67 mL, and 17.5 mL, respectively. Mean lymph node yield was 15 (range, 8 to 21).


CONCLUSIONS
A completely reusable LESS-platform is applicable to various uses in urology, yielding favorable functional and cosmetic results. Reusable materials are useful to reduce the cost of LESS, further increasing its acceptance. LESS with a completely reusable platform is more cost effective than standard laparoscopy.
Department of Urology, Eberhard-Karls University Tuebingen, Germany. christian.schwentner@med.uni-tuebingen.de
C
C
Schwentner
T
T
Todenhöfer
J
J
Seibold
S
S
Alloussi
S
S
Aufderklamm
J
J
Mischinger
A
A
Stenzl
G
G
Gakis
D000315:Adrenalectomy / Q000191:economics / Q000379:methods; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004210:Dissection / Q000379:methods; D004867:Equipment Design; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000295:instrumentation* / Q000379:methods; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics / Q000379:methods; D010147:Pain Measurement; D011446:Prospective Studies; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult