Technique of Laparoscopic-Endoscopic Single-Site Surgery Radical Nephrectomy

Background: Laparoscopic-endoscopic single-site surgery (LESS) represents the closest surgical technique to scar-free surgery. Objective: To assess the feasibility of LESS radical nephrectomy (LESS-RN). Design, setting, and participants: Ten patients with body mass index (BMI) <= 30 underwent LESS-RN for renal tumour by two experienced laparoscopists. Surgical procedure: TriPort (Olympus Winter & Ibe, Hamburg, Germany) was inserted through a transumbilical incision. A combination of standard laparoscopic instruments and flexible grasper and scissors was used. A 5-mm 30 degrees camera was also used. The standard laparoscopic transperitoneal nephrectomy technique was performed. Measurements: Patient demographics, operative details, and final pathology were prospectively recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. Results and limitations: Ten cases were successfully accomplished (two right-sided tumours and eight left-sided tumours; tumour diameter ranges: 4-8 cm). The mean patient age was 63.5 yr (22-77 yr), and median BMI was 23.56 (18.2-26.6). The mean operative time was 146.4 min (120-180 min), and the mean blood loss was 202 ml (50-900 ml). Pathological examination observed organ-confined T1 renal cell carcinoma in nine cases and pT3b tumour in one case. One bleeding complication occurred. Limitations regarding the intraoperative instrument ergonomics and the requirement for ambidexterity of the surgeon were noted. Conclusions: LESS-RN proved to be safe and feasible. Further clinical investigation in comparison to the established techniques should take place to evaluate the outcome of LESS-RN. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.