Preliminary experience with transperitoneal laparoendoscopic single-site radical nephrectomy using a home-made single-port device in China.
BACKGROUND
Laparoendoscopic single-site (LESS) surgery represents a technique to further reduce morbidity and scarring associated with surgery. We present our preliminary experience with transperitoneal LESS radical nephrectomy (RN) using a home-made single-port device in China.


METHODS
From July 2010 to November 2011, eleven patients with renal tumor not greater than T2 underwent LESS-RN by an experienced laparoscopic surgeon. A home-made single-port device was used through a 5-cm umbilical incision. A combination of standard and articulating laparoscopic instruments was used. The sequence of steps of LESS-RN was similar to transperitoneal laparoscopic RN. Patient characteristics, perioperative variables and postoperative outcomes were recorded and analyzed.


RESULTS
Except for two transperitoneal laparoscopic conversions and one hand-assisted laparoscopic conversion, the other procedures were completed successfully without conversion to open surgery. The mean operative time was 224.5 (155-297) minutes, estimated blood loss was 270.9 (50-900) ml, and hospital stay was 10.4 (5-15) days. The mean visual analog pain scale (VAPS) on the first postoperative day was 4.0/10. Final pathological analysis revealed renal cell carcinoma in all cases with a stage distribution of three T1a, five T1b, and three T2a tumors. With the mean follow-up period of 21.4 (12-28) months, all patients were alive without evidence of tumor recurrence or metastasis, and were satisfied with the appearance of the scars.


CONCLUSIONS
Transperitoneal LESS-RN using a home-made single-port device is technically feasible and safe in a selected group of patients (low body mass index and stage tumor) and has excellent cosmetic results. Although preliminary oncologic outcome is not compromised, the long-term evaluation of these patients is awaited.
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Hai
H
Bi
Department of Urology, Peking University Third Hospital, Beijing 100191, China. Email: malulin@medmail.com.cn.
Lulin
L
Ma
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Xiaofei
X
Hou
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Shudong
S
Zhang
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Guoliang
G
Wang
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Lei
L
Zhao
D000328:Adult; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002681:China; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome