New Advances in Urologic Laparoendoscopic Single Site (LESS) Surgery

Abstract

The last 30 years has seen an explosion in the development and adoption of laparoscopy as the standard of care for the treatment of many benign and malignant conditions within the majority of areas of surgical practice. Following the initial laparoscopic nephrectomy performed by Clayman, laparoscopic and robotic-assisted surgery has been applied to nearly the entire gamut of the urologic surgical repertoire. While urologic surgeons continue to strive for improvements in morbidity and the cosmetic sequelae of laparoscopic surgery, an effort has been extended toward minimization of size and number of ports required for the performance of these procedures. Laparoendoscopic single site (LESS) surgery is a recently coined term that refers to a group of techniques, which allow for laparoscopic interventions to be performed through a single abdominal incision often hidden within the umbilicus. While the term LESS has been recently developed, the concept of LESS surgery is not singular. Single incision surgery has been performed for decades during percutaneous procedures on the kidney as well as in gynecology and general surgery. The current acceleration in the interest for these techniques has been promoted by the recent introduction of new instrumentation and access devices, incorporation of novel approaches, and new and existing robotic platforms into the repertoire combined with the familiarity of current practitioners with advanced laparoscopic techniques. As such, within the past year, nearly the entire spectrum of extirpative and reconstructive urologic procedures has been performed using LESS surgery.