title: LESS living donor nephrectomy: Surgical technique and results.
abstract: OBJECTIVE
  We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014.
  
  
  METHODS
  Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery.
  
  
  RESULTS
  LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3-15), mean procedure time was 233.2 min (172-300), and hospitalization stay was 3.94 days (3-7) with a visual analogue pain score at discharge of 1.32 (0-3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1-20) and final scar length was 4.06 cm (3-5). Each allograft was functional.
  
  
  CONCLUSIONS
  Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity.
authors.affiliation: Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alessimi
authors.affiliation: Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Adam
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.affiliation: Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.affiliation: Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Codas
authors.affiliation: Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France.
authors.forename: Hakim Fassi
authors.initials: HF
authors.lastname: Fehri
authors.affiliation: Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Martin
authors.affiliation: Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Crouzet
keywords: Laparo-endoscopic single-site surgery; laparoscopy; living donor nephrectomy; minimally invasive; single port