Single-Port Laparoscopic Surgery in Urology: Initial Experience

Kaouk, Jihad; Haber, George; Goel, Raj Kumar; Desai, Mihir; Aron, Monish; Rackley, Raymond R.; Moore, Courtenay; Gill, Inderbir S.

doi:10.1016/j.urology.2007.11.034

Cited by 338 publications

(226 citation statements)

References 5 publications

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“…[46,68] Slightly difficult Lack of specifically designed cryoprobes. High Simple nephrectomy [11,12,33,35,36,39,40] Fairly difficult Besides cosmetic advantages, other benefits for the patient still need to be fully demonstrated.…”

Section: 4mentioning

confidence: 99%

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Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

et al. 2011

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LESS Natural orifice transluminal endoscopic surgery NOTES Robotics UrologyPlease visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery. Objective: To summarize and critically analyze the available evidence on the current status and future perspectives of LESS and NOTES in urology. Evidence acquisition: A comprehensive electronic literature search was conducted in June 2010 using the Medline database to identify all publications relating to NOTES and LESS in urology. Evidence synthesis: In urology, NOTES has been completed experimentally via transgastric, transvaginal, transcolonic, and transvesical routes. Initial clinical experience has shown that NOTES urologic surgery using currently available instruments is indeed possible. Nevertheless, because of the immaturity of the instrumentation, early cases have demanded high technical virtuosity. LESS can safely and effectively be performed in a variety of urologic settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low, mostly being small case series or casecontrol studies from selected centers. Thus, the only objective benefit of LESS remains the improved cosmetic outcome. Prospective, randomized studies are largely awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technology advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics is likely to drive a major paradigm shift in the development of LESS and NOTES. Conclusions: NOTES is still an investigational approach in urology. LESS has proven to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons. Development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.

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Section: 4mentioning

confidence: 99%

“…Sacral colpopexy [6,69] Difficult Demanding suturing. Medium Pyeloplasty [39,5,65,85] Difficult Demanding suturing. High Ureteral re-implantation [51] Difficult Demanding suturing High Adrenalectomy [52,67] Difficult Need for extraumbilical insertion of the multichannel port.…”

Section: Highmentioning

confidence: 99%

Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

et al. 2011

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“…The introduction of laparoscopy allowed urologists to minimize patient morbidity. Recently, however, novel modifications to laparoscopy have led to single-port surgery, [1][2][3] with laparo-endoscopic single-site surgery (LESS) as an alternative to standard laparoscopic surgery. LESS has been reported in mostly adults, with few pediatric series and no reported cases at Canadian centres.…”

Section: Introductionmentioning

confidence: 99%

Laparo-endoscopic Single Site Surgery in Pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

Khambati

Wehbi

Farhat

2015

CUAJ

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Introduction: Laparo-endoscopic single-site surgery (LESS) is becoming an alternative to standard laparoscopic surgery. Proposed advantages include enhanced cosmesis and faster recovery. We assessed the early post-operative surgical outcomes of LESS surgery utilizing different instruments in the pediatric urological population in Canada. Methods: We prospectively captured data on all patients undergoing LESS at our institution between February 2011 and August 2012. This included patient age, operative time, length of stay, complications and short-term surgical outcomes. Different instruments/devices were used to perform the procedures. Access was achieved through a transumbilical incision. Results: A total of 16 LESS procedures were performed, including seven pyeloplasties, four unilateral and one bilateral varicocelectomies, two simple nephrectomies, one renal cyst decortication and one pyelolithotomy. There was no statistical difference in the operative times, hospital length of stay and cost (pyeloplasty only) in patients undergoing pyeloplasty and varicocelectomy using the LESS technique when compared to an age matched cohort of patients managed with the traditional laparoscopic approach. One pyeloplasty in the LESS group required conversion to open due to a small intra-renal pelvis. There were no immediate or short term post-operative complications; however, one patient experienced a decrease in renal function status post LESS pyeloplasty. Since all procedures were performed by a vastly experienced surgeon at a tertiary center, the generalizability of the results cannot be assessed. Conclusions: There are only a few series that have assessed the role of LESS in pediatric urological surgery. Although our experience is limited by a heterogeneous group of patients with a short follow-up period, the present cohort demonstrates the safety and feasibility of LESS. Further evaluation with randomized studies is required to better assess the role of LESS in pediatric urology.

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“…A refinement of laparoscopic surgery, singleincision laparoscopic surgery (SILS), has more advantages over conventional multiport laparoscopic surgery (MLS), in that existing laparoscopic instruments can be used and relatively minor adjustments from the current multiport laparoscopic technique are needed. Thus far, it has been used for various abdominal procedures including cholecystectomy [6], appendectomy [7], and nephrectomy [8], and recently, this technique has been applied to colorectal surgery [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review

Αποστόλου

Orfanos²,

Papalois

et al. 2015

Indian J Surg

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As surgeons became more adept with laparoscopic colon surgery, other less invasive procedures, such as singleincision laparoscopic right hemi-colectomy (SIL-RH), have been applied. The objective of this study was to evaluate the safety of SIL-RH as well as its intraoperative and postoperative outcomes for right-sided colon diseases. A detailed search in PubMed for citations that included SIL-RH from 2000 to 2014 revealed 21 studies fulfilling the criteria of the present review. A total of 684 patients were analyzed. Of the patients, 50.2 % were men. Mean patient age was 64.8 years. Of the patients, 36.1 % had already undergone an abdominal operation before the performance of SIL-RH, while 69 % of the patients underwent SIL-RH for colon cancer. Relatively low rates of overall morbidity (15 %) and mortality (0.75 %) were reported in the included studies. Mean length of postoperative hospital stay (LOS) was 5.5 days. Bowel motility return had a mean value of 2.8 days. Mean number of harvested lymph nodes (LN) was 19.2 LN. All resection margins were tumorfree. SIL-RH was a safe alternative to multiport laparoscopic right hemi-colectomy (ML-RH) in terms of morbidity and mortality, postoperative gastrointestinal function recovery, LOS, as well as oncological radicalness.

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Single-Port Laparoscopic Surgery in Urology: Initial Experience

Cited by 338 publications

References 5 publications

Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

Laparo-endoscopic Single Site Surgery in Pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review

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