Laparoendoscopic Single-site Radical Research Articles

Comparison of Laparoendoscopic Single-Site Radical Nephrectomy with Conventional Laparoscopic Radical Nephrectomy for Localized Renal-Cell Carcinoma

To compare the results of laparoendoscopic single-site (LESS) radical nephrectomy with conventional laparoscopic radical nephrectomy for localized renal-cell carcinoma (RCC). This study was designed as a matched case-controlled study from our institute's RCC database. Nineteen consecutive patients who were undergoing LESS radical nephrectomy were compared with 38 patients who were undergoing conventional laparoscopic radical nephrectomy. The matching process accounted for sex, age, operative side, and tumor size. No significant differences were observed in mean operative time (190.8 vs 172.4 min, P = 0.249), estimated blood loss (143.2 vs 199.5 mL, P = 0.235), and complication rate (15.8% vs 21.1 %, P = 0.635) between the LESS and conventional laparoscopy groups. Postoperative hospital stay after LESS radical nephrectomy was 2.7 (2-4) days, compared with 3.9 (3-7) days in the conventional laparoscopy group (P < 0.001). Postoperative pain, as measured by visual analog scale at postoperative day 1 (4.7 vs 5.8 points, P = 0.001), 2 (3.4 vs 4.6 points, P < 0.001), and 3 (2.7 vs 4.0 points, P = 0.008) was significantly lower in the LESS group. LESS radical nephrectomy is a feasible and safe surgical option for localized RCC that demonstrates improved cosmetic outcomes and the additional benefits of decreased postoperative pain and decreased hospital stay.

Laparo-endoscopic single-site (LESS) radical nephrectomy with renal vein thrombectomy: initial report

BackgroundBy combining trocar sites and extraction incision, Laparo-endoscopic Single-site Surgery (LESS) may provide less morbidity than traditional laparoscopy. Concerns continue about LESS for locally advanced tumors. We present our experience with LESS-radical nephrectomy with renal vein thrombectomy (LESS-RN-RVT)Case PresentationBetween 5-6/2009, 2 patients underwent LESS-RN-RVT (1 right-/1 left-side). Standard steps of multi-site laparoscopic radical nephrectomy were performed, including stapled renal vein thrombectomy and intact specimen extraction. Both cases were successfully completed by LESS without complications. Mean tumor size was 7.8 cm, incision size 4.5 cm, operative time 152 min, EBL 100 ml, and hospital stay 2.5 days. Both patients had negative margins, and are alive at time of last follow-up. One did not require postoperative opiates.ConclusionsLESS-RN-RVT is safe and feasible in selected patients with renal vein thrombi. Further accumulation of data and comparison to multiport laparoscopic technique are requisite.

Percutaneous Ureteral Elevation in Laparoendoscopic Single-Site Radical Nephrectomy

To describe our technique of suture-assisted ureteral retraction during Laparoendoscopic Single-Site (LESS) radical nephrectomy. A healthy, 39-year-old woman with an incidental 5-cm enhancing left renal mass elected to undergo radical nephrectomy. A 2-cm skin incision was made in the left upper quadrant of the abdomen, and a Covidien SILS port was introduced using standard Hasson techniques. Straight and angled laparoscopic instruments were used to mobilize the kidney outside of Gerota's fascia. To place the renal vessels on stretch and facilitate hilar dissection, the ureter and lower pole attachments were encircled with a 0-Vicryl suture inserted percutaneously via a disposable fascial closure device. The kidney was bagged and removed intact. The procedure was performed without complication with a total operative time of 265 minutes. EBL was minimal at 25 mL. The patient was discharged home on postoperative day 1, and final pathology revealed stage pT1b chromophobe renal cell carcinoma with negative surgical margins. LESS radical nephrectomy is feasible in select patients. Suture-assisted retraction of the ureter and lower pole attachments using a fascial closure device facilitates safe dissection and control of the renal hilum.