title: Hybrid laparoendoscopic single-site surgery of upper urinary tract with the use of mini-laparoscopic instruments: cosmetic outcome and midterm oncological outcome.
abstract: OBJECTIVE
  To evaluate the efficacy of mini-laparoscopic instruments in combination with laparoendoscopic single-site surgery (LESS) instruments for the performance of oncological urological surgery.
  
  
  METHODS
  Thirty-five patients underwent oncological hybrid LESS either mini-laparoscopic-assisted LESS partial nephrectomy (LESS-PN, n = 12) or mini-laparoscopic-assisted LESS radical nephrectomy (LESS-RN, n = 23). Perioperative data were prospectively collected. The patient and observer scar assessment scale (POSAS) was used for the evaluation of the cosmetic outcome.
  
  
  RESULTS
  Mean tumor size treated by LESS-PNs was 28.8 (IQR 20.5-37.3) mm. Average operative time and blood loss were 123 (IQR 112.5-145) min and 158.3 (IQR 100-200) ml, respectively. Renal artery clamping took place in seven cases. LESS-RN was performed in cases with a mean tumor size of 60 (IQR 48-71.5) mm. The average operative time was 116.8 (IQR 100-130) min. Average blood loss was 137 (IQR 100-150) ml. Complications were limited to grade II according to Clavien classification. The oncological outcome, including midterm results, was directly comparable to the literature. Patients reported low pain scores and high satisfaction in terms of postoperative scarring. The POSAS scores confirmed the excellent cosmetic outcome of hybrid LESS.
  
  
  CONCLUSIONS
  The combination of mini-laparoscopic and LESS instrumentation as routine equipment of oncological surgery provided an efficient option for urologic surgery. The combination of mini-laparoscopic and LESS instruments improves the intraoperative ergonomics of LESS-PN and LESS-RN. The provided surgical and oncological outcome compares favorably to the LESS and conventional laparoscopic literature.
authors.affiliation: Department of Urology, University of Patras , Patras, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.affiliation: Department of Urology, University of Patras , Patras, Greece.
authors.forename: Jason
authors.initials: J
authors.lastname: Kyriazis
authors.affiliation: Department of Urology, University of Patras , Patras, Greece.
authors.forename: Wissam
authors.initials: W
authors.lastname: Kamal
authors.affiliation: Department of Urology, San Luigi Gonzaga Hospital-Orbassano, University of Turin, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Department of Urology, University of Patras , Patras, Greece. liatsikos@yahoo.com.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Liatsikos
mesh_terms: D000368:Aged; D002921:Cicatrix / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000601:surgery*
keywords: Laparoendoscopic; Mini-laparoscopic; Needlescopic; Nephrectomy; Scarless; Single-site