Commentary on “Laparoendoscopic single-site (LESS) partial nephrectomy short-term outcomes.” Rais-Bahrami S, George AK, Montag S, Okhunov Z, Richstone L, The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY: BJU Int 2012 (Epub ahead of print)

Abstract

Study type-therapy (case series). Level of evidence 4. What's known on the subject and what does the study add? 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 pathologic resection and excellent short-term oncologic and renal functional outcomes in the select patient-population who underwent this minimally invasive approach. To present our experience of transumbilical LESS-PN with pathologic and short-term oncologic and renal functional outcomes. In all, 15 LESS-PNs were performed for cT1a tumors between July 2008 and August 2011 by 1 surgeon. All patients underwent transumbilical LESS using a 5mm 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 analyzed. Of the 14 patients (8 men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumor size resected was 2.4 (0.8; 1.2-4.0). There were 12 renal cell carcinomas, 2 angiomyolipomas, and 2 metanephric adenomas on final pathology, all with negative margins. The mean (sd) operative duration was 169 (47) minutes with a mean (sd, range) warm ischemia time of 14.7 (13.4; 0-37) minutes; bull-dog clamps were used for hilar-control in 9 cases with the remaining 6 cases done without hilar vascular clamping. The mean (sd) estimated blood loss in this series was 293 (325)ml (median 200ml) 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 (<0.1mg/dl) at a mean (sd, range) follow-up of 17.1 (11.9; 1-36) months. LESS-PN is a feasible and effective operation, providing complete oncologic resection along with excellent short-term oncologic and renal functional outcomes.