Single-port Urological Surgery: Single-center Experience With the First 100 Cases

White, Wesley M.; Haber, Georges-Pascal; Goel, Raj Kumar; Crouzet, Sébastien; Stein, Robert J.; Kaouk, Jihad

doi:10.1016/j.urology.2009.04.030

Cited by 270 publications

(183 citation statements)

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“…White et al reported the Cleveland Clinic experience with the first 100 LESS urologic procedures [61]. Specifically, 74 patients underwent LESS renal surgery, and 26 patients underwent LESS pelvic surgery.…”

Section: Cumulative Seriesmentioning

confidence: 99%

“…As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. Unfortunately, the quality of evidence of all available studies remains low, mostly being small case series [61][62][63] (evidence level 4) or case-control studies from selected centers [64][65][66][67][68][69][70][71] (evidence level 3b). Given the limited amount of data, available reviews are narrative [11,13,14,[29][30][31]78,79] or are based on expert opinions and consensus meetings [1,2,80] (evidence level 4).…”

Section: 4mentioning

confidence: 99%

“…Medium Oncologic efficacy to be demonstrated. Radical cystectomy [60,61] Extremely difficult Demanding suturing. Low Large incision to remove the specimen hinders the advantages of the single-site procedure.…”

Section: Lowmentioning

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: Cumulative Seriesmentioning

confidence: 99%

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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“…Other practical advantages include improved pain control and decreased intra-abdominal adhesions and post surgical pain. A combination of articulating and bent instruments can allow the surgeon to partially overcome the loss of triangulation and 'clashing' of instruments (White et al, 2009). However, LESS RP is challenging surgical procedure Rabenalt et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…However, RALP needs five to seven ports and one 4-5cm wound is necessary. Interest has therefore focused on reducing the number of ports and in fact several reports of laparoendoscopic single site surgery (LESS) in the urological speciality have appeared in the literature Hidetoshi Akita 1 , Akihiro Nakane 1 , Ryosuke Ando 1 , Kenji Yamada 1 , Takahiro Kobayashi 1 , Takehiko Okamura 1 *, Kejiro Kohri 2 (Castellucci et al, 2008;Desai et al, 2008;Aron et al, 2009;White et al, 2009;Autorino et al, 2011;2012). Nevertheless, even with the use of laparoscopic curved or articulating instruments, significant 'clashing' with both the camera and other instruments can increase operative times and require significant laparoscopic skills especially for intracorporeal suturing.…”

Section: Introductionmentioning

confidence: 99%

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

Akita

Nakane²,

Ando³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy ( .6 days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8mg/patient in 2-port RP and 50.0mg/patient in LRP. Conclusions: Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

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Laparoendoscopic Single‐site Upper Tract Surgery

Tabib

Gaunay

Richstone

2018

Smith's Textbook of Endourology

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Single-port Urological Surgery: Single-center Experience With the First 100 Cases

Cited by 270 publications

References 10 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

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

Laparoendoscopic Single‐site Upper Tract Surgery

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