title: Laparoendoscopic partial nephrectomy in single-incision triangulated umbilical surgery (SITUS) technique: early experience.
abstract: BACKGROUND
  Nephron sparing surgery for renal tumors has evolved as the standard of care for resectable renal tumors. Laparoscopic partial nephrectomy (PN) has gained recognition after technical refinements were able to match the well-established criteria for open partial nephrectomy. Laparoendoscopic surgery (LESS) is one of the approaches to further minimize invasiveness of laparoscopic surgery.
  
  
  OBJECTIVE
  We report our initial experience with LESS partial nephrectomy in single-incision transumbilical surgery technique (SITUS) in daily clinical practice.
  
  
  METHODS
  From 2010, patients undergoing SITUS-PN were prospectively evaluated. Patients with small, solitary or multiple, exophytic-enhancing renal masses were selected, whereas patients with solitary kidney, endophytic or hilar tumors were excluded. Important clinical data, PADUA and RENAL score, were assessed prospectively.
  
  
  METHODS
  Patients' characteristics, perioperative, hematologic and pathologic data as well as pain evaluation using the visual analogue pain scale (VAPS) were assessed.
  
  
  CONCLUSIONS
  A total of 13 patients underwent LESS-PN/SITUS-PN (6 right and 7 left renal units). One patient was converted to conventional laparoscopy requiring two additional ports to treat bleeding from renal vessels. Pathology revealed renal cell carcinoma in nine patients, oncocytoma in one and benign cyst in three patients. No positive surgical margin was observed. The mean blood loss was 2.1 g/dl [range 0.5-4.5 g/dl] in hemoglobin. Minimal discomfort was noted at discharge (VAPS = 0.2 ± 0.6 [range 0-2]/10].
  
  
  CONCLUSIONS
  LESS partial nephrectomy in SITUS technique is feasible for selected exophytic tumors and has been integrated into our armamentarium for nephron sparing minimally invasive surgical treatment.
authors.affiliation: Department of Urology and Urological Oncology, Hanover Medical School (MHH), Carl Neuberg Str. 1, 30625, Hanover, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Wolters
authors.forename: Florian
authors.initials: F
authors.lastname: Imkamp
authors.forename: Lucy
authors.initials: L
authors.lastname: Wohlatz
authors.forename: Stephan
authors.initials: S
authors.lastname: Jutzi
authors.forename: Christoph A
authors.initials: CA
authors.lastname: von Klot
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
authors.forename: Ute
authors.initials: U
authors.lastname: Walcher
authors.forename: Udo
authors.initials: U
authors.lastname: Nagele
authors.forename: Thomas R W
authors.initials: TR
authors.lastname: Herrmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*