title: Position of laparo-endoscopic single-site surgery nephrectomy in clinical practice and comparison (matched case-control study) with standard laparoscopic nephrectomy.
abstract: BACKGROUND
  One way how to reduce morbidity and improve cosmesic of kidney surgery is single site laparoscopy. Relatively well described concept but without defined position in clincal practise.
  
  
  OBJECTIVE
  To report of institutional experience with laparoendoscopic single-site surgery (LESS) nephrectomy (NE) and compare (matched case-control study) it with that of standard laparoscopic NE (LNE).
  
  
  METHODS
  In the period 8/2011 to 10/2013, we performed 183 mini-invasive NE (132 tumours, 51 benign aetiology); 45 of them (24.6%) were LESS, the rest LNE. The main but not absolute indications for LESS were: non-obese men, and less advanced tumours. In 13 patients undergoing LESS-NEs (28.9%) there was a transumbilical approach. For the rest, a pararectal incision was performed and an accessory port was added in 31.1% (14) - 2/22 (9.1%) left sided, 12/23 (52.2%) right sided. Twenty-four LESS-NE were performed by a more experienced surgeon (mean operation time (MOT) 73.1 min), 21 LESS-NE by 4 other surgeons (MOT 132.8 min). These 24 were compared with 43 LNE done by the same surgeon before the period of LESS (1/2007-8/2011) and with similar characteristics of cases (body mass index (BMI) ≤ 35 kg/m(2), less advanced tumour).
  
  
  RESULTS
  We found no statistically significant differences in any of the parameters studied. The MOT 73.1 min vs. 75.0 min (p = 0.78), BMI 27.4 kg/m(2) vs. 29.2 kg/m(2) (p = 0.08), blood loss 54.7 vs. 39.2 (p = 0.47). Complications (4.2% vs. 11.6%) were only of internal character in origin. No conversion in either group. In LESS-NE, staplers were used more frequently (more expensive than clips) for division of renal hilar vessels (70.8% vs. 51.2%). The mean price of LESS-NE was €367 higher.
  
  
  CONCLUSIONS
  The LESS NE performed by an experienced surgeon is a safe and efficient method for the surgical treatment of both malignant and benign renal conditions in patients with BMI < 30 kg/m(2) and with low-stage tumours. The LESS NE is more expensive compared to LNE.
authors.affiliation: Department of Urology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.affiliation: Department of Urology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
authors.forename: Viktor
authors.initials: V
authors.lastname: Eret
authors.affiliation: Department of Urology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Stránský
authors.affiliation: Department of Urology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Trávníček
authors.affiliation: Department of Urology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Urge
authors.affiliation: Department of Radiology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Ferda
authors.affiliation: Department of Pathology, National University Health System, Singapore.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Petersson
authors.affiliation: Department of Pathology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Hes
keywords: kidney tumour; laparoendoscopic single-site surgery; laparoscopy; nephrectomy