title: Retroperitoneoscopic single site renal biopsy surgery: right indications for the right technique.
abstract: BACKGROUND
  Laparoendoscopic single-site surgery (LESS) has been developed in an attempt to further reduce the morbidity and scarring associated with laparoscopic surgery. In patients in whom there are indications to perform a laparoscopic renal biopsy, LESS surgery is a valid alternative to mini invasive surgery and is becoming more common. We report our experience on 14 renal biopsy procedures performed in a retroperitoneal LESS.
  
  
  METHODS
  LESS renal biopsy was performed in 14 patients 18 to 80 years old (mean age 58.3 years) during a 36 month period. All procedures were performed by a single operator. The patient was in a standard flank position. The procedure was performed using a 2.5 cm, single incision via a retroperitoneal access at the Petit's triangle. A 5 mm biopsy forceps was used to collect the specimen under direct vision, and haemostasis was obtained with an Argon beam probe and the application of oxidized regenerated cellulose gauze.
  
  
  RESULTS
  Biopsy was performed successfully in all cases. Mean operative time was 52.64 min, blood loss was minimal, and the hospital stay ranged from 12 to 24 hours. None of the patients required narcotics or additional analgesia in the postoperative period. No postoperative complications occurred.
  
  
  CONCLUSIONS
  The LESS technique is safe, reliable (100% success), easy to learn, and offers subjective cosmetic benefits to the patient. Minimal hospitalization requirement following retroperitoneal LESS biopsy is an additional timely advantage over laparoscopic renal biopsy. We think that with the right indications (marked obesity, failure of previous percutaneous biopsy attempts, a solitary kidney and coagulopathy) LESS renal biopsy is a good alternative to laparoscopy. Our next step will be a randomized prospective study of LESS compared with laparoscopy for renal biopsy to support our findings.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.affiliation: Policlinico di Modena, Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena 41124, Italy. alessio_zordani@hotmail.it.
authors.forename: Alessio
authors.initials: A
authors.lastname: Zordani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Galli
authors.forename: Eugenio
authors.initials: E
authors.lastname: Martorana
authors.forename: Micaela
authors.initials: M
authors.lastname: Piccoli
authors.forename: Gianni
authors.initials: G
authors.lastname: Cappelli
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012187:Retroperitoneal Space / Q000601:surgery*