Laparoendoscopic Single-Site Surgery: Early Experience with Tumor Nephrectomy

Background and Purpose: Laparoendoscopic single-site surgery ( LESS) represents the closest surgical technique to scar-free surgery. We performed LESS for renal tumor nephrectomy in eight patients to assess feasibility and perioperative outcome. Patients and Methods: Eight patients with a body mass index ( BMI) <= 30 underwent single-port nephrectomy for renal tumor by an experienced laparoscopic surgeon. Tri-Ports were used through a transumbilical incision in all cases. A flexible grasper and a 5-mm 30-degree high-definition camera were used in addition to standard laparoscopic equipment. Patient demographics; operative details, including procedure duration, blood loss, and complications; and final pathology results were prospectively recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. Results: All LESS nephrectomy operations were successfully accomplished without the need to convert to conventional laparoscopy. The median patient age was 60.75 years ( range 22-76 years) and median BMI was 22.95 ( range 18.2-26.1). The median operative duration was 141 minutes ( range 120-180 min), and the median blood loss was 103 mL ( range 50-150 mL). Histologic evaluation confirmed complete excision of an intact specimen. All cases revealed organ-confined T-1 renal-cell carcinoma ( two right-sided and six left-sided, tumor diameter range 4-8 cm). A tumor with an adjacent simple renal cyst was excised in one patient. No intraoperative or postoperative complications occurred. Conclusions: LESS was a feasible and safe approach in a selected group of patients ( low BMI and stage tumor). LESS nephrectomy was made possible with the use of multi-instrument port and flexible instruments. The oncologic outcome was not compromised. Further evaluation of LESS surgery needs prospective, randomized studies.