Laparoendoscopic Single-site Surgery Cases Research Articles

Laparoendoscopic single-site surgeries: A multicenter experience of 469 cases in Japan.

To report on a multi-institutional series of non-robotic urological laparoendoscopic single-site surgery in Japan. Consecutive cases of laparoendoscopic single-site surgery carried out between February 2009 and December 2012 at nine academic institutions were included. We examined the surgical outcomes, including conversion and complications rates. Four hundred and sixty-nine cases were included in the analysis. The most common procedure was adrenalectomy (n = 177) and the second most common procedure was radical nephrectomy (n = 143). The procedures also included nephroureterectomy (n = 40), living donor nephrectomy (n = 40), pyeloplasty (n = 30), urachal remnant excision (n = 9), simple nephrectomy (n = 7), radical prostatectomy (n = 6) and others (n = 17). The access sites included umbilicus (n = 248, 53%) and other sites (n = 221, 47%). A transperitoneal approach was used in 385 cases (82%), and retroperitoneal approach in 84 cases (18%). The median operation time of all procedures was 198 min. Conversion to reduced port surgery, conventional laparoscopy, or open surgery was noted in 27 cases (5.8%), 12 cases (2.6%), and two cases (0.4%), respectively, with an overall conversion rate of 8.7%. Intraoperative complications occurred in 10 cases (2.1%). Post-operative complications were noted in 29 cases (6.2%), including five major complications (1.1%). No mortality was recorded in this series. Non-robotic laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases in Japan. Furthermore, urological laparoendoscopic single-site surgery is a promising minimally invasive surgical option that is feasible for experienced urological surgeons in intermediate-volume centers as well as high-volume centers.

MP23-16 EVALUATION OF THE ROLE OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS MINILAPAROSCOPY FOR TREATMENT OF DIFFERENT UPPER URINARY TRACT PATHOLOGIES: PROSPECTIVE RANDOMIZED COMPARATIVE STUDY

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2016MP23-16 EVALUATION OF THE ROLE OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS MINILAPAROSCOPY FOR TREATMENT OF DIFFERENT UPPER URINARY TRACT PATHOLOGIES: PROSPECTIVE RANDOMIZED COMPARATIVE STUDY Aly Abdel-Karim, Elsaid Yahia, Mohamed Hassouna, and Salah Elsalmy Aly Abdel-KarimAly Abdel-Karim More articles by this author , Elsaid YahiaElsaid Yahia More articles by this author , Mohamed HassounaMohamed Hassouna More articles by this author , and Salah ElsalmySalah Elsalmy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.738AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Direct comparative prospective studies between laparoendoscopic single-site surgery (LESS) and minilaparoscopy ML are still lacking. We present the first prospective double-blind randomized study to compare between LESS and ML for treatment of different upper urinary tract pathologies. METHODS During the period of January 2013 and June 2015, patients with different upper urinary pathologies who were candied for laparoscopic surgical intervension were blindly randomized to both LESS and CL. ML was done by 3-mm instruments; including 3-mm laparoscope. All procedures were done by a single experienced laparoscopist. Exclusion criteria included children less than 3 years and absolute contraindications of laparoscopy. Both groups were compared regarding patients demographic data, operative time, intraoperative and postoperative complications, estimated blood loss (EBL), hospital stay, analgesic requirement, visual analogue pain scale (VAS) on discharge and cosmetic outcome. Cosmetic outcome was assessed at 6 months postoperatively using the patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS Included were 60 patients with mean age of 40.7±9.2 years and 39.6±16.7 years both in LESS and ML, respectively. Mean BMI was 29.5±3.4 and 28.6±4.37 kg/m2 in LESS and ML groups, respectively. In LESS group there were 2 adrenalectomies, 9 nephrectomies (5 simple and 4 radical), 9 pyeloplasties and 9 cyst marsuplizations and a case of retrocaval ureter. While in ML group there were 3 adrenalectomies, 9 nephrectomies (5 simple and 4 radical), 9 pyeloplasties and 9 cyst marsuplizations. Operative time in LESS was 167 ±24 min which was longer than that of ML group (145±39 min) but statistically insignificant. EBL in LESS was 59±34 ml Vs 43± 42 ml in ML and the difference was statistically insignificant. VAS was significantly less in LESS group (1.7±0.6 in LESS and 2.8±0.5 in ML). In LESS group, PSAS was 5.9±0.85 while OSAS was 10.6±1.98. Meanwhile, In ML group, PSAS was 8.9±0.9 and OSAS 13.5±6.3. The difference was statistically significant. There were no intra-operative complications in both groups. Post-operative complications were reported in 6.6% and 3.3% both in LESS and ML groups; respectively. Mean hospital stay was 1.8±1.3 days in LESS Vs 2.1±0.8 days in ML. Mean analgesic requirements in the post-operative period was 151.7±35.6 mg of Diclofenac Na in LESS Vs 169.7±47.3 mg in ML. There were no conversions to either open surgery or conventional laparoscopy in both groups. 5-mm extra port was added in 4 cases of LESS. Meanwhile, in ML group we used a 10-mm port in 12 cases in order to use the Hem-O-lock clip applier. CONCLUSIONS Both LESS and ML are feasible and safe options for treatment of different upper urinary tract pathologies with comparable operative time, blood loss, hospital stay and complication rate. However, LESS is associated with less analgesic requirement and better cosmetic outcome. Each procedure has its own technical limitations. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e267-e268 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Aly Abdel-Karim More articles by this author Elsaid Yahia More articles by this author Mohamed Hassouna More articles by this author Salah Elsalmy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology

To review peri-procedural outcomes from a large, multi-institutional series of pediatric urology patients treated with laparaendoscopic single-site surgery (LESS) for major extirpative and reconstructive procedures. Consecutive LESS cases between January 2011 and May 2014 from three free-standing pediatric referral centers were reviewed. Data include age, sex, operative time, blood loss, length of stay, and complications according to the modified Clavien-Dindo classification. Hasson technique was used for peritoneal entry, GelPOINT advanced access platform was inserted, and standard 5mm laparoscopic instruments were used. Fifty-nine patients (median age 5 years, 4 months-17 years) met inclusion criteria: 29 nephrectomies, 9 nephroureterectomies, 3 bilateral nephrectomies, 5 heminephrectomies, 5 renal cyst decortications, 3 bilateral gonadectomies, 2 Malone antegrade continence enema, 2 calyceal diverticulectomy, and 1 ovarian detorsion with cystectomy. Median operative times for each case type were comparable to published experiences with traditional laparoscopy. Overall mean and median length of stay was 36.2 hours and 1 day, respectively. There were two complications: port site hernia requiring surgical repair (Clavien IIIb) and a superficial port site infection that resolved with antibiotics (Clavien II). Cosmetic outcomes were subjectively well received by patients and their parents. Operative time was significantly shorter between the first half of the experience and the second half (102 vs 70 minutes, P < .05). LESS approach can be broadly applied across many major extirpative and reconstructive procedures within pediatric urology. Our series advances our field's utilization of this technique and its safety.

Laparoendoscopic single-site surgery (LESS) for large benign adnexal tumors: one surgeon’s experience over one-year period

Objective: To present the authors’ experience with laparoendoscopic single-site surgery (LESS) surgery for large benign adnexal tumors and to compare the removal time of resected specimen with that of conventional laparoscopy. Study Design: Ten consecutive patients underwent LESS for huge adnexal tumors at Myongjil Hospital, Korea between March 2011 and July 2012. A modified open Hasson technique was used to gain access to the abdominal cavity. The single-port device was inserted trans-umbilically into the wound opening. After suction of large amount of fluid content, LESS salpingo-oophorectomy was performed. The resected adnexal specimen was placed into a LapBag for removal out of the abdominal cavity. The authors compared the removal time of resected specimen between LESS and previously performed conventional laparoscopy for large benign adnexal tumors. Results: The adnexal tumors in this study were all very large cystic tumors reaching near or over the umbilicus. It took less than ten minutes for the removal of the resected adnexal tumors in all LESS cases (three to ten minutes), much less time than that of the conventional laparoscopy (usually ten to 17 minutes). Conclusion: LESS for large benign adnexal tumors is feasible and removal of resected adnexal tumor is easier than conventional laparoscopic surgery.

Is Laparoendoscopic Single-site Surgery a Viable Approach for Radical Nephrectomy With Renal Vein Thrombus? Comparison With Multiport Laparoscopy

To compare laparoendoscopic single-site surgery (LESS) and multiport laparoscopy (MPL) for radical nephrectomy and renal vein thrombectomy (RN-RVT) because concerns continue regarding the suitability of LESS for advanced renal tumors. We initiated a retrospective analysis of 26 patients who underwent RN-RVT (11 LESS, 15 MPL) between January 2006 and September 2011. LESS transperitoneal access was obtained by a periumbilical incision through which all trocars were inserted. LESS-RN-RVT recapitulated steps of MPL-RN-RVT, including stapled RVT and intact specimen extraction. Demographic factors and tumor characteristics, perioperative variables, and complications and outcomes were analyzed. Primary outcome was discharge visual analog pain score. Median follow-up was 20.8 months. The 15 MPL cases were successfully completed laparoscopically; 1 of 11 LESS cases required insertion of an additional 5-mm port at a separate site. There were no significant demographic differences between the 2 groups. For LESS-RN-RVT andMPL-RN-RVT, mean tumor diameter was 7.1 and 7.9 cm (P= .346), mean RENAL nephrometry score was 10.2 and 10.5 (P= .407), mean operative time was 147 and 161 minutes (P= .331), and mean estimated blood loss was 122 and 170 mL (P= .282). Significantly lower visual analog pain score at discharge (1.1 vs 2.7, P= .001), narcotic requirement (8.3 vs 14 mg, P= .049), and hospital stay (2.6 vs 3.7 days, P= .032) were noted for LESS vs MPL patients. Both groups had negative margins. There were no significant differences in complications or transfusions or in disease-free and overall survival. LESS was comparable to MPL-RN-RVT for perioperative parameters and may confer benefit with pain and hospital stay. Further study is requisite to establish the role of LESS in the management of renal neoplasms with RVT.

Laparoendoscopic single site (LESS) surgery in benign gynecology: perioperative and late complications of 515 cases

To present 515 LESS surgeries and report the perioperative outcomes and late complications according to the Clavien-Dindo classification. We performed a prospective single-center study (Canadian Task Force classification II-2). One surgeon trained in minimally invasive surgery performed 515 cases of LESS surgery from May 2008 to September 2011. LESS gynecological surgery was performed on 515 patients (274 total hysterectomies; 26 subtotal hysterectomies; 87 adnexectomies including oophorectomy, salpingectomy, and salpingo-oophorectomy; 100 ovarian cystectomies; 17 myomectomies; 11 others). The median age and body mass index of the patients were 45 years and 22.6 kg/m², respectively. LESS surgery was successfully completed in 493 patients (95.7%) without the need for one or more ancillary ports or conversion to laparotomy. Twenty patients needed one or more additional ports and two cases were converted to laparotomy. One or more additional ports were required most frequently in ovarian cystectomy procedures (12/100, 12%). Thirty-six patients (7.0%) required intraoperative and/or postoperative transfusions. Each of these patients underwent hysterectomy (33/274, 12.0%) or subtotal hysterectomy (3/26, 11.5%). Perioperative complications (<30 postoperative days), excluding transfusions, occurred in 8 patients (1.6%) and included one case each of vault bleeding, vault abscess, stump watery discharge, rectal injury, and vesicovaginal fistula, and three cases of urinary tract injury. Late complications occurred in three patients (0.6%) and included two umbilical hernias and one vault evisceration. The overall complication rate, excluding transfusions, was 2.1% (11/515). The rate of late postoperative complications, including umbilical port site hernia and vault evisceration, was not increased in this study, as compared to previous reports of single-port and conventional laparoscopic surgeries.

Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy

Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, the umbilicus, within which a multiple-entry portal is placed into a 3.0-4.0-cm single incision to perform operations. The objective of this study was to compare incision size, wound complications, and postoperative pain of LESS compared with those of laparoscopic cholecystectomy (LC). A prospective randomized controlled study was conducted between January and June 2011 at two university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients were randomly assigned to undergo laparoscopic or LESS cholecystectomy. Skin and aponeurosis wound sizes were recorded. A 10-point visual analog scale (VAS) was used to assess pain at postoperative hours 3 and 24. Healing and wound complications were assessed at follow-up. A total of 57 patients, 53 women and 4 men with a mean age of 48.7 years, were randomly assigned to undergo LESS (n = 28) or LC (n = 29). The mean length of the umbilical skin incision was 4.0 cm (range = 2.1-5.8) in LESS and 2.7 cm (1.5-5.1) in LC (p < .0001). The mean internal aponeurosis diameter was 3.5 cm (2.0-5.5) in LESS and 2.3 cm (1.2-3.5) in LC (p < .0001). The mean operative time was 60.3 min (32-128) for LESS and 51.3 min (25-120) for LC (p = 0.11). Gallbladder perforation at detachment occurred in 15.69 % of the LESS cases and in 5.88 % of the LC cases (p = 0.028). The mean VAS score for pain at hour 3 was 2.0 points (0-7) for the LESS group and 4.0 (0-10) for the LC group (p = 0.07), and at postoperative hour 24 it was 0.3 points (0-6) for LESS and 2.3 (0-10) for LC (p = 0.03). There were no significant differences in wound complications. Incisional hernias were not found in either group. The LESS single-port (SP) operations demand a bigger incision than LC surgery. However, there were no differences in healing, wound infections, and hernia development. We found a tendency of less postoperative pain associated with LESS/SP than with LC.

Two Cases of Laparoendoscopic Single-Site Surgery (LESS) for Symptomatic Adnexal Masses during the Second Trimester of Pregnancy

Two Cases of Laparoendoscopic Single-Site Surgery (LESS) for Symptomatic Adnexal Masses during the Second Trimester of Pregnancy

Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases

Background: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective: To report a large multi-institutional worldwide series of LESS in urology. Design, setting, and participants: Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Intervention: Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Measurements: Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Results and limitations: Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site.

778 IS THERE A PERIOPERATIVE ADVANTAGE TO ROBOTIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY VERSUS CONVENTIONAL LESS PYELOPLASTY?

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011778 IS THERE A PERIOPERATIVE ADVANTAGE TO ROBOTIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY VERSUS CONVENTIONAL LESS PYELOPLASTY? Ephrem Olweny, Sara Best, and Jeffrey Cadeddu Ephrem OlwenyEphrem Olweny Dallas, TX More articles by this author , Sara BestSara Best Dallas, TX More articles by this author , and Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1817AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site surgery (LESS) continues to gain enthusiasm in urology, but is technically challenging owing to instrument clashing, loss of instrument triangulation, and difficulty sewing. Application of the da Vinci Si™ robotic surgical system to LESS (R-LESS) may help overcome these challenges. We describe our initial experience with R-LESS pyeloplasty, and compare perioperative outcomes to conventional LESS pyeloplasty. METHODS Between May and October, 2010, 5 patients underwent R-LESS pyeloplasty at our institution. Outcomes were compared to those for the 10 most recent patients who underwent conventional LESS pyeloplasty. Surgical indication in all cases was relief of symptoms. LESS pyeloplasty was performed using 3 5-mm trocars (4/10), or the GelPOINT™ platform (Applied Medical, Rancho Santa Margarita, CA) (6/10), through a single 3-cm umbilical incision. A lateral 3-mm instrument was necessary to facilitate triangulation for the anastomosis. Antegrade JJ stent insertion was performed. R-LESS pyeloplasty was performed using the robotic instruments, camera, and a 5-mm assist port through a GelPOINT™ platform. Retrograde JJ stent insertion was performed. For all right-sided R-LESS and LESS cases, a 3-mm liver retractor was inserted through a separate stab incision. RESULTS For R-LESS vs. LESS respectively, there were no significant differences in age, gender distribution, BMI, proportion with prior abdominal surgery, estimated blood loss (56 vs. 42 ml; p=0.55), or hospital length of stay (2.3 vs. 2.6 days; p=0.60). Mean operative time was longer for R-LESS (228.2 vs. 188.3 min; p=0.02). Subjectively, there was significantly less instrument clashing with R-LESS, and the anastomosis could be completed without the need for an additional lateral instrument. There were no intra- or perioperative complications in the R-LESS group, while 2 conversions to conventional laparoscopy, and 2 Clavien Grade 3b postoperative complications occurred in the LESS group. CONCLUSIONS Initial experience with R-LESS pyeloplasty is favorable, with improved ergonomics (particularly the anastomosis), fewer complications, and equivalent perioperative outcomes to conventional LESS pyeloplasty. Operative times were modestly longer, likely attributable to the additional step of cystoscopy and JJ stent placement. Further improvements in technique with development of robotic systems specific to R-LESS are anticipated. Short and long-term functional outcome data are pending. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e313 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ephrem Olweny Dallas, TX More articles by this author Sara Best Dallas, TX More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ex-vivo training model for laparoendoscopic single-site surgery

BACKGROUND:Laparoendoscopic single-site surgery (LESS) has recently been applied successfully in the performance of a host of surgical procedures. Preliminary consensus from the experts is that this mode of surgery is technically challenging and requires expertise. The transition from trainee to practicing surgeon, especially in complex procedures with challenging learning curves, takes time and mentor-guided nurturing. However, the trainee needs to use platforms of training to gain the skills that are deemed necessary for undertaking the live human case.OBJECTIVE:This article aims to demonstrate a step-by-step means of how to acquire the necessary instrumentation and build a training model for practicing steeplechase exercises in LESS for urological surgeons and trainees. The tool built as a result of this could set the platform for performance of basic and advanced skills uptake using conventional, bent and articulated instruments. A preliminary construct validity of the platform was conducted.MATERIALS AND METHODS:A box model was fitted with an R-Port™ and camera. Articulated and conventional instruments were used to demonstrate basic exercises (e.g. glove pattern cutting, loop stacking and suturing) and advanced exercises (e.g. pyeloplasty). The validation included medical students (M), final year laparoscopic fellows (F) and experienced consultant laparoscopic surgeons (C) with at least 50 LESS cases experience in total, were tested on eight basic skill tasks (S) including manipulation of the flexible cystoscope (S1), hand eye coordination (S2), cutting with flexible scissors (S3), grasping with flexible needle holders (S4), two-handed maneuvers (S5), object translocation (S6), cross hand suturing with flexible instruments (S7) and conduction of an ex-vivo pyeloplasty.RESULTS:The successful application of the box model was demonstrated by trainee based exercises. The cost of the kit with circulated materials was less than £150 (Pounds Sterling). The noncamera handling skills (S2–S8) of the ex-vivo training model for LESS can distinguish between laparoscopically naïve fellows and experienced consultants in LESS. S4–S8 showed the highest level of construct validity, by accurately differentiating among the M, F and C groups.CONCLUSION:LESS requires a significant amount of skill and has an inherent steep learning curve. The ex-vivo model described provides a cost-effective means that a trainee or training unit can build for optimising preliminary skill acquisition in LESS for urological trainees. It has construct validity in several tasks. Such platform models should be tested further with an emphasis on rapid sequence uptake of optimal skills, prior to undertaking the live human case.

Minimally Invasive Nephrectomy: The Influence of Laparoendoscopic Single-site Surgery on Patient Selection, Outcomes, and Morbidity

To define clinical scenarios in urology for which laparoendoscopic single-site surgery (LESS) is indicated and likely to be successful. We report a series of LESS nephrectomies and compare patient characteristics with traditional laparoscopic nephrectomies performed during the same time period. We retrospectively reviewed all laparoscopic nephrectomies (conventional or LESS) performed by a single surgeon at our institution since our initial LESS cases in August 2007. Patients were not randomized; instead the surgeon used clinical judgment to decide with the patient which procedure should be performed. Factors that may have influenced this decision were retrospectively analyzed. Of all minimally invasive nephrectomies, 47% were performed using LESS technique (30/64). One conversion from LESS to standard laparoscopy occurred. Patients undergoing LESS had a smaller median age (47 vs 63.5 years, P = .004), body mass index (24.4 vs 28.4, P = .001), tumor size in nephrectomies performed for suspected malignancy (4 cm vs 6 cm, P = .043), and hospital length of stay (42.7 vs 46.1 hours, P = .006). LESS patients were also more likely to be undergoing a nephrectomy for a benign indication (50% vs 15%, P = .006). The complication rate for LESS and conventional laparoscopy was 13% (4/30) and 15% (5/34), respectively, with similar distributions across Clavien grades. With appropriate patient selection, almost 50% of minimally invasive nephrectomies can be performed using LESS with similar complication rates and outcomes compared with traditional laparoscopy. Younger, thinner patients with nononcological indications or smaller tumors are prime candidates for LESS nephrectomy.

Complications and conversions of upper tract urological laparoendoscopic single-site surgery (LESS): multicentre experience: results from the NOTES Working Group

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Several studies have shown the feasibility of performing both complex and reconstructive laparoendoscopic single site (LESS) surgical procedures in urology. To date, no studies have evaluated the rates of conversion to conventional laparoscopy and complications at the time of LESS procedures in urology. This study, a compilation of results from members of the NOTES working group, is the first study to address the rates of complications and conversions to conventional laparoscopy at the time of LESS surgery in urology. • To present complications and rates of conversion from LESS to conventional laparoscopy (CL) at the time of upper tract LESS urologic procedures. • Patients undergoing LESS upper tract procedures between September, 2007 and November, 2008 (n = 125) were identified at six high-volume academic centers pioneering urologic LESS procedures. All LESS procedures were performed transperitoneally via a single umbilical incision using either adjacent conventional trocars or a dedicated single-site access device. Reconstructive procedures incorporating a single planned 2 mm accessory needle port were included as LESS procedures and were not considered conversions. • Patients, undergoing LESS procedures requiring conversion to CL with the placement of additional ports were identified. Conversion was defined as the placement of additional 5 or 10/12 mm ports beyond the primary incision. In each case the operative reports were reviewed, the reason for conversion was determined, and the number and types of additional ports and complications were noted. • Upper tract LESS procedures were performed in 125 patients comprising 13.3% of the total 937 laparoscopic procedures performed at the participating institutions during this time period. Conversion to CL was necessary in 7 patients (5.6%) undergoing LESS requiring the addition of 2-5 ports. • Reasons for conversion included: facilitate dissection in 3 (43%), facilitate reconstruction in 3 (43%), and control of bleeding in 1 (14%). All attempted LESS cases were completed laparoscopically without need for open conversion. • Complications occurred in 15.2% of patients undergoing LESS surgery. Three of the 7 patients that required conversion to CL developed postoperative complications (Clavien grade II in two and IIIa in one). • Limitations of this study included the inability to standardize LESS patient selection criteria, instrumentation and surgical technique as well as the lack of available complete data from a CL control group for comparison. • LESS surgery is technically feasible for a variety of upper urinary tract reconstructive and ablative procedures, although it appears to be associated with higher rates of complications than in mature CL series. Conversion to CL occurs infrequently and may be a reflection of stringent patient selection.

Psychosocial and marketing challenges for Natural Orifice Transluminal Endoscopic Surgery and Laparoendoscopic Single‐site Surgery

The introduction of laparoscopic techniques in the late 1980s and early 1990s has ushered in a novel era in the surgical treatment of human diseases. Following the first laparoscopic nephrectomy done by Clayman et al . in 1991 [1], the initially noted advantages of minimally invasive urological surgery were later proved [2,3]. This soon led to the transition from novelty to the current concept of established ‘expectations’. Despite the success of conventional laparoscopic urological surgery, incisions ranging from 1 to 3 cm in length and three to five ports in number are still required. Each additional working port increases the inherent risk of bleeding, infection, concordant organ damage, hernia formation and decreased cosmetic outcome.

904 PROSPECTIVE COMPARISON OF LAPARO-ENDOSCOPIC SINGLE-SITE SURGERY AND MULTIPORT LAPAROSCOPY FOR UPPER URINARY TRACT SURGERY: INITIAL OUTCOMES

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy II1 Apr 2010904 PROSPECTIVE COMPARISON OF LAPARO-ENDOSCOPIC SINGLE-SITE SURGERY AND MULTIPORT LAPAROSCOPY FOR UPPER URINARY TRACT SURGERY: INITIAL OUTCOMES Wassim Bazzi, Jonathan Silberstein, Sean Stroup, Elana Godebu, Kyoko Sakamoto, Tracy Downs, Christopher Kane, and Ithaar Derweesh Wassim BazziWassim Bazzi More articles by this author , Jonathan SilbersteinJonathan Silberstein More articles by this author , Sean StroupSean Stroup More articles by this author , Elana GodebuElana Godebu More articles by this author , Kyoko SakamotoKyoko Sakamoto More articles by this author , Tracy DownsTracy Downs More articles by this author , Christopher KaneChristopher Kane More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1660AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparo-endoscopic Single-site Surgery (LESS) is an emerging platform which may represent a further decrease in morbidity compared to multi-port laparoscopy (MPL). We prospectively compared LESS and MPL approaches for laparoscopic Radical Nephrectomy (RN) and Partial Nephrectomy (PN). METHODS Single surgeon (IHD) nonrandomized prospective comparison of LESS and MPL RN and PN. All LESS were performed at UCSD Medical Center; all MPL were performed at San Diego VAMC. 20 patients underwent LESS (10 RN/10 PN) and 20 patients underwent MPL (14 RN/6 PN) from 2/2009-9/2009. All cases were performed with via transperitoneal approach. For LESS-RN and -PN, transperitoneal access was obtained by peri-umbilical incision through which all trocars were inserted. LESS-RN and -PN recapitulated all standard steps of MPL-RN and -PN. Demographic factors/tumor characteristics, peri-operative variables, outcomes and complications were recorded and analyzed. RESULTS All 20 MPL cases were successfully completed laparoscopically. 18/20 LESS cases were successfully performed; one LESS-PN was converted to MPL-PN and another was converted to open PN for non-progression. There were no significant differences with respect to demographic factors between the two groups. For LESS-PN and MPL-PN: mean tumor diameter (cm) was 2.2 and 2.8 (p=0.284); mean ischemia time (min) was 22.2 and 25.4 (p=0.772); operative time (min) was 170 and 149 (p=0.109). There were no significant differences with respect to preoperative/postoperative serum creatinine (p=0.238) and estimated glomerular filtration rate (p=0.697). For LESS-RN and MPL-RN: mean tumor diameter (cm) was 5.7 and 5.6 (p=0.998); mean operative time (min) was 149.1 and 159.5 (p=0.347); mean estimated blood loss (mL) was 162.5 and 167.9, respectively (p=0.910). For the LESS group, mean incision size was 4.1 cm. For LESS and MPL groups: mean hospital stay (days) was 3.3 and 4.1 (p=0.117); percent requiring postoperative opiate supplementation was 55.0% and 85.0% (p=0.039) and analgesic use (6 morphine equivalents vs. 11.6, p=0.050). No patients required transfusions, all had negative margins, and all are currently alive with no significant differences in complication rates (p=0.687). CONCLUSIONS In this well matched prospective comparison, LESS is comparable to MPL in terms of perioperative parameters and may confer benefit with respect to analgesic requirement. Randomized evaluation and longer-term assessment and follow up are requisite. La Jolla, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e353 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wassim Bazzi More articles by this author Jonathan Silberstein More articles by this author Sean Stroup More articles by this author Elana Godebu More articles by this author Kyoko Sakamoto More articles by this author Tracy Downs More articles by this author Christopher Kane More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...