Laparoendoscopic Single-site Surgery Approach Research Articles

Infrarenal Para-Aortic Lymphadenectomy via Laparoendoscopic Single-Site Approach

Video Objective To perform the procedure of Laparoendoscopic Single-Site surgery (LESS) for infrarenal para-aortic nodal dissection and demonstrate the feasibility and safety of infrarenal para-aortic lymphadenectomy via LESS Setting A 59-year old female who has no special past history presented an university and tertiary care hospital with abnormal uterus bleeding after menopause. The bimanual examination was no special. The laboratory test was normal, exceptionally, the CA-125 level of 181.6 U/ml (normal Interventions The comprehensive staging surgery was performed by an experienced gynecologist via LESS approach. The comprehensive staging surgery was successfully completed, and the video mainly show the para-aortic lymph nodes dissection up to level of left renal vein. The operation time of the para-aortic lymphadenectomy was 100 min. There were no intra- and post-operative complications. The histopathology was well-differentiated endometrial adenocarcinoma with deep myometrium invasion but the bilateral adnexa, the 17 pelvic nodes and the 18 para-aortic nodes were negative. The FIGO stage was IB Conclusion The para-aortic lymphadenectomy up to the level of infrarenal vein is feasible via LESS. The LESS approach can provide easier access to the upper abdominal regions comparing with traditional laparoscopy and facilitate the high level para-aortic lymphadenectomy, with the advantage of faster recovery, shorter hospital day, lesser postoperative pain and incisional mobility and better cosmetic result.

Single-Incision Hysterectomy Outcomes With and Without Robotic Assistance

Objective:To evaluate the differences in operative time and postoperative complications for total laparoscopic hysterectomy (TLH) performed using conventional laparoendoscopic single-site surgery (LESS) versus a robotic-assisted LESS approach.Methods:A retrospective study was conducted of all cases of conventional LESS TLH (n = 47) and robotic LESS TLH (n = 129) for benign gynecologic conditions performed from November 2014 to October 2017. Patient characteristics, operative time for hysterectomy, estimated blood loss, duration of hospitalization, and short-term postoperative complications were compared using appropriate parametric and nonparametric statistical tests.Results:Conventional LESS TLH cases had a 16.36-minute longer mean operative time for hysterectomy (P < .01). No difference was found in uterine weight, estimated blood loss, hospitalization, or incidence of postoperative complications when LESS TLH was performed with or without robotic assistance. When comparing uterine weight < 100 g, conventional LESS TLH cases had significantly greater operative time than the robotic LESS TLH cases (78.10 ± 23.97 minutes vs. 59.97 ± 35.17 minutes, P < .01). When comparing uterine weight > 100 g, conventional LESS TLH cases again had significantly greater operative time than the robotic LESS TLH cases (98.73 ± 50.16 minutes vs. 80.00 ± 42.97 minutes, P < .01). There was no difference in postoperative complications.Conclusion:Robotic single-incision laparoscopy can result in decreased operative time compared to a conventional LESS approach. Robotic-assisted and conventional LESS are similar in rate of postoperative complications, if performed by surgeons with abundant LESS experience.

Is there a role for single-port laparoscopy in the treatment of endometriosis?

Endometriosis is among the most common benign gynecological conditions, and it affects 6-15% of women of reproductive. During recent decades, minimally invasive surgical techniques, and especially laparoscopy, have gained significant ground concerning the treatment of gynecological disorders. To date, laparoscopy is considered the gold standard for the diagnosis and treatment of endometriosis. Available English-language papers in PubMed and Scopus databases have been used for the current narrative review. Data from all relevant literature regarding single-port laparoscopy and treatment of endometriosis have been extracted. The main key words used by the authors for the search were: single-port laparoscopy, endometriosis and laparoscopy. Two authors (A.D. and K.C.) performed the data base search and extraction of relevant studies, and a third author (E.A.) consented to the study selection of the 23 relevant papers, consulted and approved the final presentation of the results and conclusions. To date, the laparo-endoscopic single-site surgery (LESS) technique has been used for a variety of procedures in gynecology as well as for a variety of diagnoses. Thus, adhesiolysis, ovarian endometrioma enucleation and salpingo-oophorectomy can be easily performed using the LESS approach. Novel single-site trocars as well as appropriate curved instruments are being designed and produced to facilitate the surgeon utilizing such a demanding technique. However, single-site surgery does not seem to have a place to date in the treatment of deep infiltrating endometriosis due to the complicated surgical maneuvers required for the treatment of this condition combined with technical difficulties posed by the loss of triangulation, and the instrument crowding when LESS is implemented. Apart from being feasible, LESS has also proven to be non-inferior in terms of surgical safety and efficacy, and according to most, but not all, reports, better in terms of cosmetics and postoperative body image perception. Currently, it has been shown that most of the gynecologic operations are feasible using the LESS approach. So, this approach has a role to play in the treatment of endometriosis too, especially concerning the most common manifestations of the disease. However, more extensive research is required to properly evaluate single-port access techniques to conventional minimally invasive ones in the treatment of the different manifestations of endometriosis, concerning short term as well as long term outcomes of the treatment, including the ones associated to fertility.

Laparoendoscopic Single-Site Surgery for Large Dermoid Cyst: Surgical Technique Modifications

Abstract Introduction: With the advent of laparoendoscopic single-site surgery (LESS) techniques emerging as viable, feasible, and widely applicable minimally invasive procedures,1–8 it is likely that its role in gynecologic surgery will be increasingly recognized. Numerous studies9–14 have shown that LESS can help to improve cosmesis and potentially reduce postoperative pain. We aim to describe our surgical technique to carry out the LESS approach through transumbilical access to remove a large dermoid cyst of the ovary in a patient who had subsequent melanoma excision and skin grafting at the interscapular region. The video run time is 6 minutes 34 seconds. The video includes the surgical procedure using our modified technique, the postoperative surgical scar, and the comparison of our surgical technique with the conventional cystectomy surgical technique. Materials and Methods: The patient is a 35-year-old Caucasian lady who underwent a two-step surgery to remove (1) a large 100×77×90mm right-sided der...

Single-access laparoscopic approach in the surgical treatment of endometrial cancer: A single-institution experience and review of literature.

BACKGROUND:The aim of this study was to assess the surgical and oncological outcome for the management of endometrial cancer (EC) by laparoendoscopic single-site surgery (LESS).PATIENTS AND METHODS:We performed a retrospective chart review of patients who underwent a LESS for EC. All the patients were treated by the same surgical team between July 2009 and June 2013 at the Gynaecologic Oncologic Unit, Regina Elena National Cancer Institute, Rome, Italy.RESULTS:A total of 50 women were included, with a median age of 45 years (range, 39-84 years) and a median body mass index (BMI) of 21.8 kg/m2 (range, 19-48 kg/m2). Median operative time was 100 min (range, 50-240 min), median blood loss was 90 mL (range, 10-300 mL) and median hospital stay was 3 days (range, 2-9 days). The median number of pelvic lymph nodes retrieved was 14 (range, 5-20). No intraoperative complications occurred, but there were 4 postoperative complications. Two patients required a laparoscopic conversion. The median follow-up was 36 months (range, 16-62 months) and no recurrence occurred.CONCLUSION:Our report showed that the LESS approach in the treatment of early EC can be a safe and reliable technique in terms of surgical and oncological outcomes.

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 adrenalectomy - own experience and matched case-control study with standard laparoscopic adrenalectomy.

IntroductionAt our institution, laparoendoscopic single-site surgery (LESS) has been established as a technique for laparoscopic nephrectomy since 2011, and since 2012 in selected cases for adrenalectomy (AE) as well.AimTo compare LESS AE with standard laparoscopic AE (SLAE).Material and methodsBetween 3/2012 and 7/2014, 35 adrenalectomies were performed. In 18 (51.4%), a LESS approach was chosen. Indications were strictly non-complicated cases (body mass index (BMI) < 34 kg/m2, tumour ≤ 7 cm, non-malignant aetiology, no previous surgery). All LESS procedures were done by one surgeon. Standard equipment was a 10 mm rigid 0° camera, Triport+, one pre-bent grasper, and a sealing instrument. The approach was pararectal in all cases except one (transumbilical in a slim man). Three patients with LESS were excluded (2 partial AEs only, one adrenal cancer converted to SLAE and then to open surgery). These 15 LESS AE procedures were compared to 15 SLAEs with similar characteristics chosen among 54 SLAEs performed in the period 1/2008–2/2012.ResultsIn 8 cases (53.3%) of LESS AE, a 3 mm port was added to elevate the liver/spleen. Mean parameters of LESS AE vs. SLAE (Wilcoxon test): maximal tumour diameter 43.7 mm vs. 36.1 mm (p = 0.28), time of surgery 63.3 min vs. 55.3 min (p = 0.22), blood loss 38.0 ml vs. 38.0 ml (p = 0.38), BMI 26.9 kg/m2 vs. 28.5 kg/m2 (p = 0.13), discharge from hospital 5.4 days vs. 3.9 days (p = 0.038). There were no complications in either group.ConclusionsThe LESS AE is feasible in selected cases, especially small left-sided tumours in thin patients with no history of previous abdominal operations, but requires an additional port in half of the cases.

Transvesical Laparoendoscopic Single Site Surgery to Remove Surgical Materials Penetrating the Bladder: Initial Clinical Experience in 9 Female Patients

The optimal approach for removing surgical materials that have penetrated the bladder is still debatable. We reviewed our initial experience with transvesical (percutaneous intraluminal access) laparoendoscopic single site surgery to treat such complications. We determined the safety, efficacy and morbidity of the procedure. In this case series study 9 women 24 to 63 years old were operated on from November 2009 to July 2012 due to bladder tape/mesh or surgical suture extrusion using the transvesical (percutaneous intraluminal access) laparoendoscopic single site surgery approach. We used the TriPort™ or TriPort+ single site access system, and a combination of straight and articulating or only standard laparoscopic instruments. A running V-Loc™ suture was placed as needed. In all cases followup included urine tests, abdominal ultrasound and cystoscopy. Mean operative time was 59 minutes (range 35 to 105). Median postoperative hospital stay was 2.4 days. No blood loss or complications were observed except 1 conversion to open surgery because of a perivesical abscess. No extra port was added. No adverse events related to the method were observed during the mean 19-month followup. In 1 patient mesh extrusion recurred after 12 months of followup. We consider this technique to be an efficient, safe procedure and a valuable minimally invasive treatment option for foreign body removal from the bladder. However, further observations are needed to prove the validity of the method.

Combined surgical procedures using laparoendoscopic single-site surgery approach

As our experience with laparoendoscopic single-site (LESS) surgeries increased, we considered how it might be employed if two or more surgeries were to be combined. LESS surgeries' cosmetic advantages, decreased parietal trauma and better patient satisfaction relative to standard multiport laparoscopy have been previously reported, but its special role in combined surgeries has never been stressed. In this series, we present the advantages of LESS procedure over multiport laparoscopy in combined surgical procedures. To the best of our knowledge, this has never been reported before. A retrospective analysis of 27 patients was performed. The patients underwent combined LESS procedures between February 2010 and January 2012 at GEM Hospital, Coimbatore, India. All patients were of ASA grade 1 or 2. Patients with previous surgery in the umbilical region were not offered single-incision surgery. We successfully performed 27 combined LESS procedures over a span of 2 years. Twenty patients were women and seven were men. Mean age was 35.94 years (range, 10-66 years). Mean BMI was 27.2. There were no major intraoperative complications. Mean blood loss was 45.7 mL (range, 0.0-120.0 mL). Mean postoperative hospital stay was 3.08 days (range, 1-5 days). When a suitable case of multiple pathologies is encountered and LESS surgery is feasible for all of them, performing LESS surgery not only has cosmetic advantages over standard laparoscopy, but it also avoids the need for additional ports to achieve adequate visualization and access. All quadrants of the abdomen remain under reach through umbilicus.

Pure single-port laparoscopic surgery or mix of techniques?

Laparoendoscopic single-site surgery (LESS) has emerged in the recent years as an alternative approach to conventional laparoscopic surgery which is accompanied by additional advantages over laparoscopy. In this work we attempt to review the current literature and to investigate the possible combination of LESS to other currently available approaches such as natural orifice transluminal endoscopic surgery (NOTES), needlescopic and robotic laparoscopic surgery. Extensive literature search on the topics of LESS, hybrid and pure NOTES, Needlescopic-assisted LESS and "Robot-assisted LESS" took place. Additionally, the accumulated experience from 118 LESSs performed in our departments is presented in an attempt to provide evidence regarding the mix of technique in LESS in urology. The challenging nature of LESS limits the broader application and acceptance. Expanding experience in single-site surgery has currently provided tools such as transvaginal access, needlescopic instruments and robot assistance that can aid LESS and enhance its efficiency without compromising any of its advantages. A mix of these techniques with LESS could ease the stiff learning curve of the second and benefit not only its performance but also the adaptation of LESS as a standard practice. Pure LESS although feasible, remains a technical challenge for the surgeon, preventing the widespread application of the technique. The goal of urologists on LESS surgery should not be the purity of LESS approach, but the superiority against already established techniques. A mix of techniques could be a key for the documentation of the advantages of LESS over conventional laparoscopy.

V1027 LESS RADICAL NEPHRECTOMY

You have accessJournal of UrologyKidney & Ureter Oncology1 Apr 2011V1027 LESS RADICAL NEPHRECTOMY Vincent Flamand, Rafael Sanchez-Salas, François Rozet, Marc Galiano, Xavier Cathelineau, Eric Barret, and Guy Vallancien Vincent FlamandVincent Flamand Lille, France More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas Paris, France More articles by this author , François RozetFrançois Rozet Paris, France More articles by this author , Marc GalianoMarc Galiano Paris, France More articles by this author , Xavier CathelineauXavier Cathelineau Paris, France More articles by this author , Eric BarretEric Barret Paris, France More articles by this author , and Guy VallancienGuy Vallancien Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1062AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site surgery (LESS) has been reported as technically feasible in numerous ablative and reconstructive urologic procedures, particularly with radical nephrectomy (RN). We present our initial experience with LESS RN in addition to a comparison with the conventional laparoscopic approach. METHODS A transperitoneal transumbilical approach was employed for all cases with a Gelpoint® platform for access. A 3 cm omega-shaped incision was performed at the umbilicus. Three 5mm trocars were positioned. Interventions were performed with a 5 mm 30° endoscope, conventional laparoscopic instruments, and ultrasonic shears. Conventional laparoscopic technique steps were applied in these operations (Colon mobilization, hilum dissection and control, ureter section and final specimen dissection). A percutaneous renal suspension aiming to expand surgical field was done for all cases. Final specimens were extracted by the umbilical incision. RESULTS An analysis was performed comparing LESS (n=6) vs conventional (n=9). There was no significant difference between mean ages in both groups (68 vs 69, p=0.74). Median tumor size was 55.4 vs 63mm (p=0.47). All final pathology were confirmed RCC. There was a significant difference noted in mean operative time analyses (152.5min LESS vs 118.3 min conventional, p=0.03). CONCLUSIONS LESS approach is a feasible challenging technique without increasing morbidity. However operative time for the LESS approach is longer compared with conventional laparoscopy in our preliminary experience. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e414 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vincent Flamand Lille, France More articles by this author Rafael Sanchez-Salas Paris, France More articles by this author François Rozet Paris, France More articles by this author Marc Galiano Paris, France More articles by this author Xavier Cathelineau Paris, France More articles by this author Eric Barret Paris, France More articles by this author Guy Vallancien Paris, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Early surgeon impressions and technical difficulty associated with laparoendoscopic single-site surgery: a Society of American Gastrointestinal and Endoscopic Surgeons learning center study

Interest in laparoendoscopic single-site surgery (LESS) is growing rapidly among surgeons. This study aimed to characterize current surgeon impressions about LESS and to determine the relative difficulty of performing a simulated LESS task using a multiport access device. This study was conducted at the 2009 Society of Gastrointestinal Endoscopic Surgeons (SAGES) Learning Center. The 56 study participants were asked to complete pre- and post-test questionnaires regarding their level of training, prior clinical experience, and opinions about LESS. Technical skill performance was evaluated using the standardized fundamentals of laparoscopic surgery Peg Transfer task scored according to time and error metrics. The participants completed three repetitions: conventional laparoscopy (LAP), LESS with nonarticulated instruments (LESS Straight), and LESS with articulated instruments (LESS Articulating). Complete data were collected for 45 (80%) of the 56 participants, which included 27 practicing surgeons, nine minimally invasive surgery (MIS) fellows, seven residents, and two allied health professionals. Five surgeons (LESS experienced) had managed at least one LESS case in the preceding 6 months. Participants rated their comfort with LESS as 2.0 ± 1.2 (5-point scale, 1 = very uncomfortable). Compared with conventional laparoscopy, the participants indicated that LESS had 97% better cosmesis, 25% decreased postoperative pain, 18% faster recovery, 97% more demanding, 73% increased rate of complications, and 82% anticipated wide adoption. They all indicated a readiness to offer LESS to their patients if appropriately trained. Peg Transfer performance was significantly worse for LESS than for LAP (40-65% performance decline), and for LESS Articulating than for LESS Straight (44% performance decline). Construct validity for the LESS simulated tasks was supported because the LESS-experienced scores were significantly better than the LESS-nonexpert scores. Despite the increased technical difficulty associated with the LESS approach, surgeons are enthusiastic about offering these techniques and seeking additional training. Robust simulation-based methods that foster skill acquisition through repetitive practice and verification of proficiency are needed such that safe adoption may be fostered.

Urologic laparoendoscopic single-site surgery

Laparoendoscopic single-site surgery (LESS) probably represents the next evolutionary step in laparoscopic surgery. Although most urologic procedures are feasible by the LESS approach, significant challenges in terms of intraoperative ergonomics and requirement for laparoscopic skill are present. New, specially designed instruments and ports represent a solution for combating ergonomic problems during surgery. Documentation of the advantages of LESS over other approaches is currently lacking, as comparative clinical trials are scarce in the literature; in the absence of such information, the technique has been accepted at centers of laparoscopic expertise. Thus, further prospective randomized clinical trials are necessary to fully characterize the outcomes of LESS.

Current status of laparoendoscopic single-site surgery in urology

Laparoendoscopic single-site surgery (LESS) uses single incisions for the introduction of instruments through a specially designed multi-lumen single port (multi-port) for the performance of several urologic procedures. Literature review regarding the LESS approach took place on May 2009 and the experiences of our institutions were also included. Almost all urologic intra-abdominal and pelvic procedures have been successfully and safely performed with the LESS approach. Nevertheless, current experience is limited and there are significant technical challenges to the performance of LESS techniques. Wider adaptation of the approach requires refinement of LESS instrumentation to overcome the technical challenges of the approach. The improved outcome should also be documented with further clinical evaluation.