Editorial Comment

Abstract

The authors are to be commended on exploring the merits of the LESS platform for partial nephrectomy in a child. Although they demonstrate the feasibility and safety of this approach, as well as the benefit of improved cosmesis and reduced analgesic requirement, which has been reported by other investigators in pediatric patients, 1 Kaouk J.H. Palmer J.S. Single-port laparoscopic surgery: initial experience in children for varicocelectomy. BJU Int. 2008; 102: 97-99 Crossref PubMed Scopus (178) Google Scholar , 2 Park Y.H. Kang M.Y. Jeong M.S. Choi H. Kim H.H. Laparoendoscopic single-site nephrectomy using a homemade single-port device for single-system ectopic ureter in a child: initial case report. J Endourol. 2009; 23: 833-835 Crossref PubMed Scopus (69) Google Scholar , 3 Bayazit Y. Aridogan I.A. Abat D. Satar N. Doran S. Pediatric transumbilical laparoendoscopic single-site nephroureterectomy: initial report. Urology. 2009; 74: 1116-1119 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar they acknowledge some of the key drawbacks that have been encountered and commented upon by other pioneers in this field (e.g., longer warm ischemia time, difficulty suturing, instrument clashing). 4 Aron M. Canes D. Desai M.M. Haber G.P. Kaouk J.H. Gill I.S. Transumbilical single-port laparoscopic partial nephrectomy. BJU Int. 2009; 103: 516-521 Crossref PubMed Scopus (145) Google Scholar Although this report is limited by its lack of long-term follow up, it adds to a growing body of exciting literature on the feasibility of increasingly complex minimally invasive procedures using various LESS platforms. Nonetheless, pediatric LESS partial nephrectomy is a procedure whose limitations are a direct consequence of the limited experience and evolving enabling technology. As such, its performance and evaluation should be carried out by experienced minimally invasive/pediatric urological surgeons. Ideally, a prospective multicenter comparison with multiport laparoscopy should be performed in the pediatric population to determine whether there is any substantive advantage for the LESS platform. Pediatric Laparoendoscopic Single-site Partial Nephrectomy: Initial ReportUrologyVol. 76Issue 1PreviewWe present a case of transumbilical laparoendoscopic single-site surgery (LESS) for partial nephrectomy in a child. Full-Text PDF ReplyUrologyVol. 76Issue 1PreviewWe appreciate the reviewer's comments. Presently, laparoscopic partial nephrectomy is considered a key treatment measure for small renal mass cases. Particularly in cases of a large-sized mass or those in which a mass was placed in the location where resection could not be easily performed, surgery after the clamping of renal vessels is considered crucial to reduce the bleeding or to more easily confirm the tumor resection margin. From this aspect, the current initial clinical report in pediatric urology describes a LESS partial nephrectomy after the clamping of renal vessels. Full-Text PDF