title: Laparo-endoscopic single-site radical cystectomy with orthotopic urinary diversion: Technique, feasibility, and the 3-year follow-up.
abstract: OBJECTIVE
  To assess the feasibility, operative morbidity and oncological outcome of laparoendoscopic single-site (LESS) radical cystectomy.
  
  
  METHODS
  Ten patients with clinical stage T1-T2 bladder cancer underwent a LESS radical cystectomy. The mean (SD) age of the patients was 64.8 (8.6) years and their mean body mass index was 25.9 (2.7) kg/m(2). The procedure was done via a single-incision laparoscopic surgery port using a rigid 5-mm 30° long-shaft laparoscope in addition to the two working instruments. A 7-cm Pfannenstiel incision was made to remove the specimens and to allow the creation of an ileal neobladder with hand assistance.
  
  
  RESULTS
  In eight patients the LESS radical cystectomy was completed as scheduled, with the other two requiring a conversion, one to an open procedure due to locally advanced disease, and the other to conventional laparoscopy due to gas leakage. The mean (SD) operative duration was 236 (49) min, with a mean estimated blood loss of 575 (113) mL, and a mean hospital stay of 5.5 (0.7) days. No postoperative analgesic medications were prescribed and patients returned to normal activity after a mean (SD) of 17.6 (2.6) days. The pathological examination showed negative surgical margins for the bladder specimens, with a mean (SD) of 14 (1.9) lymph nodes retrieved. Seven patients were cancer-free within a mean (SD, range) follow-up of 37 (6, 29-44) months.
  
  
  CONCLUSIONS
  LESS radical cystectomy is technically feasible, with a favourable course and convalescence, and it has an acceptable oncological outcome.
authors.affiliation: Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdallah
authors.affiliation: Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdel-Hakiem
authors.affiliation: Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Feel
keywords: ASA, American Society of Anesthesiologists; BMI, body mass index; Bladder cancer; LESS; LESS, laparo-endoscopic single-site; RC, radical cystectomy; Radical cystectomy; SILS, single-incision laparoscopic surgery