Laparoendoscopic single‐site (LESS) partial nephrectomy short‐term outcomes

Abstract

• Laparoendoscopic single-site (LESS) surgery has been used by urologists for a broad range of operations including LESS partial nephrectomy (LESS-PN). To date, experiences of LESS-PN have been presented as small series or as a subset of larger heterogeneous operative experiences, which have shown the overall feasibility and safety of this novel technique.• We report our experience with LESS-PN with complete pathological resection and excellent short-term oncological and renal functional outcomes in the select patient population who underwent this minimally invasive approach. Objective• To present our experience of transumbilical laparoendoscopic single-site (LESS) partial nephrectomy (PN) with pathological and short-term oncological and renal functional outcomes. Patients and Methods• In all, 15 LESS-PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon.• All patients underwent transumbilical LESS using a 5-mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments.• The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN. • Demographic, perioperative, and postoperative variables were recorded and analysed. Results• Of the 14 patients (eight men), undergoing 15 distinct LESS-PN, the mean (SD) age was 57.9 (8.7) years and the mean (SD, range) tumour size resected was 2.4 (0.8; 1.2-4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins.• The mean (SD) operative duration was 169 (47) min with a mean (SD, range) warm ischaemia time of 14.7 (13.4; 0-37) min; bull-dog clamps were used for hilar-control in nine cases with the remaining six cases done without hilar vascular clamping.• The mean (SD) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions.• The mean (SD) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg.• Follow-up surveillance imaging showed no recurrence at a mean (SD, range) follow-up of 18.3 (12.2; 6-36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (SD, range) follow-up of 17.1 (11.9; 1-36) months. Conclusion• LESS-PN is a feasible and effective operation, providing complete oncological resection along with excellent short-term oncological and renal functional outcomes.

Analysis of oncological outcomes and renal function after laparoendoscopic single‐site (LESS) partial nephrectomy: a multi‐institutional outcome analysis

“…After the first report by Aron et al. on their initial experiences with ischaemic LESS‐PN, several studies have reported on the problems and challenges encountered during LESS‐PN . Recently, a review of the literature that was focused on this kind of surgery showed that it was exclusively performed by very skilled laparoscopic surgeons.…”

Clampless laparoendoscopic single‐site partial nephrectomy for renal cancer with low PADUA score: technique and surgical outcomes

“…In fact, many institutions have made a safe stepwise transition from standard laparoscopy to LESS surgery for selected indications, but LESS surgery has not replaced standard laparoscopy even at high‐volume institutions performing the technique . LESS PN has been reported so far by few groups . Aron et al.…”

“…In fact, many institutions have made a safe stepwise transition from standard laparoscopy to LESS surgery for selected indications, but LESS surgery has not replaced standard laparoscopy even at high-volume institutions performing the technique [12]. LESS PN has been reported so far by few groups [14,[22][23][24][25][26]. Aron et al [22] reported five selected cases (inclusion criteria: BMI <30 kg/m 2 ; tumour size <7 cm; anterior exophytic tumour at the interpolar or lower pole location; and no previous abdominal surgery).…”

Laparoendoscopic single‐site (LESS) robot‐assisted partial nephrectomy (RAPN) reduces postoperative wound pain without a rise in complication rates

“…Despite the technical challenges of LESS, Rais‐Bahrami et al. reported no PSMs and an excellent short‐term oncological outcome in their 16 cases. Bazzi et al.…”