Preliminary experience with transperitoneal laparoendoscopic single-site radical nephrectomy using a home-made single-port device in China

Background Laparoendoscopic single-site （LESS） surgery represents a technique to further reduce morbidity and scarring associated with surgery.We present our preliminary experience with transperitoneal LESS radical nephrectomy （RN） using a home-made single-port device in China.Methods From July 2010 to November 2011,eleven patients with renal tumor not greater than T2 underwent LESS-RN by an experienced laparoscopic surgeon.A home-made single-port device was used through a 5-cm umbilical incision.A combination of standard and articulating laparoscopic instruments was used.The sequence of steps of LESS-RN was similar to transperitoneal laparoscopic RN.Patient characteristics,perioperative variables and postoperative outcomes were recorded and analyzed.Results Except for two transperitoneal laparoscopic conversions and one hand-assisted laparoscopic conversion,the other procedures were completed successfully without conversion to open surgery.The mean operative time was 224.5 （155-297） minutes,estimated blood loss was 270.9 （50-900） ml,and hospital stay was 10.4 （5-15） days.The mean visual analog pain scale （VAPS） on the first postoperative day was 4.0/10.Final pathological analysis revealed renal cell carcinoma in all cases with a stage distribution of three T1a,five T1b,and three T2a tumors.With the mean followup period of 21.4 （12-28） months,all patients were alive without evidence of tumor recurrence or metastasis,and were satisfied with the appearance of the scars.Conclusion Transperitoneal LESS-RN using a home-made single-port device is technically feasible and safe in a selected group of patients （low body mass index and stage tumor） and has excellent cosmetic results.Although preliminary oncologic outcome is not compromised,the long-term evaluation of these patients is awaited.

Single-site laparoscopic partial nephrectomy: Where are we going?

AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.