Laparoendoscopic Single-site Partial Nephrectomy Research Articles

91 Optimal outcome of laparoendoscopic single-site partial nephrectomy: Analysis of predictive factors in a multi-institutional dataset

91 Optimal outcome of laparoendoscopic single-site partial nephrectomy: Analysis of predictive factors in a multi-institutional dataset

V1 Clampless laparoendoscopic single-site partial nephrectomy for renal cancer with low PADUA score: Technique and surgical outcomes

V1 Clampless laparoendoscopic single-site partial nephrectomy for renal cancer with low PADUA score: Technique and surgical outcomes

Clampless laparoendoscopic single‐site partial nephrectomy for renal cancer with low PADUA score: technique and surgical outcomes

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Laparoendoscopic single-site (LESS) surgery has proved to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons in well-selected patients. All extirpative and reconstructive urological procedures have been described in the literature, but LESS partial nephrectomy (PN) is one of the most complex procedures and few studies have been published on this subject. The study describes a clampless technique for LESS PN, by reducing the blood pressure and increasing the intra-abdominal pressure of the pneumoperitoneum to 20 mmHg, timed to precisely coincide with excision of the tumour. This technique was found to be safe and feasible in the treatment of low-risk T1a RCC. To describe the technique and report the surgical outcomes of clampless laparoendoscopic single-site (LESS) partial nephrectomy (PN) in the treatment of renal cell carcinoma (RCC) with low PADUA score. Clampless LESS PN was performed in 14 patients with cT1a renal tumours. Indications to perform a clampless LESS PN were low-risk, laterally based renal tumours, located away from the renal hilum, with a PADUA score ≤7. Demographic data and peri-operative and postoperative variables were recorded and analysed. Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR) pre- and postoperatively and at 6-month follow-up. The median operating time was 120 min and warm ischaemia time was zero in all cases. Only one early complication (Clavien grade 1) was recorded: one patient developed a flank haematoma which it was possible to treat by conservative therapy. Serum creatinine and modification of diet renal disease eGFR were not found to be significantly different pre- and postoperatively and at 6-month follow-up. Definitive pathological results showed 12 pT1a RCCs and two pT1a-chromophobe RCCs. All tumours were removed with negative surgical margins. All patients were satisfied with the cosmetic results. At a median (range) follow-up period of 12 (8-15) months, all patients were alive without evidence of tumour recurrence or port-site metastasis. Clampless LESS PN is a safe and feasible surgical procedure in the treatment of low-risk T1a RCC, with excellent cosmetic results.

Commentary on “Laparoendoscopic single-site (LESS) partial nephrectomy short-term outcomes.” Rais-Bahrami S, George AK, Montag S, Okhunov Z, Richstone L, The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY: BJU Int 2012 (Epub ahead of print)

Study type-therapy (case series). Level of evidence 4. What's known on the subject and what does the study add? Laparoendoscopic single-site (LESS) surgery has been used by urologists for a broad-range of operations including LESS partial nephrectomy (LESS-PN). To date, experiences of LESS-PN have been presented as small series or as a subset of larger heterogeneous operative experiences, which have shown the overall feasibility and safety of this novel technique. We report our experience with LESS-PN with complete pathologic resection and excellent short-term oncologic and renal functional outcomes in the select patient-population who underwent this minimally invasive approach. To present our experience of transumbilical LESS-PN with pathologic and short-term oncologic and renal functional outcomes. In all, 15 LESS-PNs were performed for cT1a tumors between July 2008 and August 2011 by 1 surgeon. All patients underwent transumbilical LESS using a 5mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments. The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN. Demographic, perioperative, and postoperative variables were recorded and analyzed. Of the 14 patients (8 men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumor size resected was 2.4 (0.8; 1.2-4.0). There were 12 renal cell carcinomas, 2 angiomyolipomas, and 2 metanephric adenomas on final pathology, all with negative margins. The mean (sd) operative duration was 169 (47) minutes with a mean (sd, range) warm ischemia time of 14.7 (13.4; 0-37) minutes; bull-dog clamps were used for hilar-control in 9 cases with the remaining 6 cases done without hilar vascular clamping. The mean (sd) estimated blood loss in this series was 293 (325)ml (median 200ml) and no cases required intraoperative or postoperative blood transfusions. The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6)mg. Follow-up surveillance imaging showed no recurrence at a mean (sd, range) follow-up of 18.3 (12.2; 6-36) months and a negligible change in serum creatinine (<0.1mg/dl) at a mean (sd, range) follow-up of 17.1 (11.9; 1-36) months. LESS-PN is a feasible and effective operation, providing complete oncologic resection along with excellent short-term oncologic and renal functional outcomes.

Comparison of Laparoendoscopic Single-site and Multiport Laparoscopic Radical and Partial Nephrectomy: A Prospective, Nonrandomized Study

To prospectively compare outcomes of laparoendoscopic single-site and multiport laparoscopic radical nephrectomy and partial nephrectomy, focusing on postoperative pain and analgesic requirement. Nonrandomized, prospective comparison of laparoendoscopic single-site and multiport laparoscopic radical nephrectomy and partial nephrectomy. Thirty-four patients underwent laparoendoscopic single-site (17 radical nephrectomy/17 partial nephrectomy); 42 underwent multiport laparoscopy (28 radical nephrectomy/14 partial nephrectomy) from February 2009 to February 2010. Laparoendoscopic single-site transperitoneal access was obtained by periumbilical incision through which all trocars were inserted. Laparoendoscopic radical nephrectomy/partial nephrectomy recapitulated steps of multiport laparoscopic radical nephrectomy/partial nephrectomy. Demographics/tumor characteristics, outcomes, and complications were analyzed. Forty-two of 42 multiport laparoscopic and 32/34 laparoendoscopic single-site cases were successfully performed. Mean follow-up was 16.2 months. For laparoendoscopic single-site and multiport laparoscopy groups mean operating room time (min) was 159.3 vs 158.9 (P = .952); mean estimated blood loss (mL) was 175.7 vs 156.1 (P = .553); percent transfused was 2.9% vs 0% (P = .925). No significant differences in complications were noted (P = .745). Significant decrease in analgesic use (6 morphine equivalents vs 11.6, P < .001) and discharge pain score (1.7 vs 2.7, P < .01) were noted in laparoendoscopic single-site vs multiport laparoscopic radical nephrectomy. For laparoendoscopic single-site partial nephrectomy and multiport laparoscopic partial nephrectomy, no significant differences were noted for tumor diameter (1.8 vs 2.0 cm, P = .57), RENAL score (0.962), ischemia time (28.6 vs 27.5 minutes, P = .70), and preoperative (P = .78)/postoperative creatinine (P = .32). For laparoendoscopic single-site radical nephrectomy and multiport laparoscopic radical nephrectomy, no significant differences were noted for mean tumor diameter (5.6 vs 5.3 cm, P = .63), RENAL score (P = .815), and mean operative time (142.3 vs 155.4 minutes P = .13). In this well-matched, prospective comparison, laparoendoscopic single-site is comparable with multiport laparoscopic surgery in terms of perioperative parameters and may confer benefit with respect to analgesic requirement. Randomized evaluation and longer-term follow-up are necessary.

Laparoendoscopic Single-site Partial Nephrectomy Without Ischemia for Very Small, Exophytic Renal Masses: Surgical Details and Functional Outcomes

BackgroundLaparoendoscopic single-site surgery (LESS) has emerged as a natural progression from standard laparoscopy aiming to further minimize the morbidity of urologic procedures. ObjectiveTo describe our technique and report the surgical and functional outcomes of unclamped LESS partial nephrectomy (PN) in the treatment of small renal masses (SRMs). Design, setting, and participantsProspective evaluation of pre- and postoperative variables of patients undergoing the LESS-PN without ischemia between 2009 and 2012. The indications were single exophytic SRMs. Surgical procedureUnclamped LESS-PN was performed through a transperitoneal approach. A pararectal Hasson access technique was preferred. Single-port access was achieved via different single-port devices. A combination of straight and articulating laparoscopic instruments was used. The tumor was excised using bipolar scissors during normal renal perfusion. Hemostasis was achieved by bipolar electrocautery, parenchymal stitches, and hemostatic agents. Outcome measurements and statistical analysisDemographic, operative, postoperative, and pathologic outcomes data were recorded and analyzed. Results and limitationsA total of 21 LESS-PN were performed (operative time: 111±41min; blood loss: 196±195ml: tumor size: 2.0±0.3cm). Neither conversion to open surgery nor transfusions occurred. Three patients required conversion to standard laparoscopy. Postoperatively, three complications (Clavien grades 2, 3a, and 4) were recorded. Pathologic examination revealed 14 clear cell carcinomas, four renal cysts, two oncocytomas, and one angiomyolipoma. Hospital stay was 4.4±1.9 d. At the last follow-up (mean: 17±11.5 mo), no port-site, local, or distant recurrences were detected. No significant variation in serum creatinine and estimated glomerular filtration rate was observed. Subjective scar evaluation indicated 66% of patients were very satisfied/enthusiastic. Study limitations include the small sample size, the lack of a control group, the short follow-up period, and the arbitrary measure of patient's scar perception. ConclusionsUnclamped LESS-PN for selected SRMs is a safe and feasible procedure providing favorable postoperative outcomes and ensuring high levels of subjective, cosmetic satisfaction.

Laparoendoscopic single‐site (LESS) partial nephrectomy short‐term outcomes

To present our experience of transumbilical laparoendoscopic single-site (LESS) partial nephrectomy (PN) with pathological and short-term oncological and renal functional outcomes. In all, 15 LESS-PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon. All patients underwent transumbilical LESS using a 5-mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments. The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN. Demographic, perioperative, and postoperative variables were recorded and analysed. Of the 14 patients (eight men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2-4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins. The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0-37) min; bull-dog clamps were used for hilar-control in nine cases with the remaining six cases done without hilar vascular clamping. The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions. The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg. Follow-up surveillance imaging showed no recurrence at a mean (sd, range) follow-up of 18.3 (12.2; 6-36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow-up of 17.1 (11.9; 1-36) months. LESS-PN is a feasible and effective operation, providing complete oncological resection along with excellent short-term oncological and renal functional outcomes.

Transumbilical laparoendoscopic single-site partial nephrectomy using a microwave tissue coagulator

Transumbilical single-port laparoscopy has emerged as a method to further enhance cosmetic benefits and reduce morbidity. We present an initial experience with transumbilical laparoendoscopic single-site partial nephrectomy (LESS-PN). A 36-year-old woman visited our hospital for the treatment of a left exophytic renal cell carcinoma, 17 mm in diameter, located at the lower pole. We decided to use transumbilical LESS-PN to treat this case. A multichannel port was placed through the center of the umbilicus, and the tumor was exposed using bent laparoscopic instruments. The tumor was then removed after microwave tissue coagulation. All procedures were performed without renal artery occlusion, and only slight bleeding occurred. Transumbilical LESS-PN using a microwave tissue coagulator was performed with an excellent cosmetic outcome and no complications. To the best of our knowledge, this is the first report of LESS-PN using a microwave tissue coagulator.

Laparoendoscopic single-site partial nephrectomy using a novel Spider surgical platform in pigs

Objective To use Spider system,a novel laparoendoscopic single-site(LESS)platform,for partial nephrectomy in pigs,so as to evaluate the feasibility and ergonomic features of the Spider system.Methods A 2cm incision was made on the lateral border of the rectus muscle;the subcutaneous tissues and muscle layer were dissected bluntly by the Kelly clamp.With the outside sheath the Spider system was introduced into the peritoneal cavity.After establishment of pneumoperitoneum,a 5mm scopy was introduced.The whole Spider platform was fixed using the suspension system on the bedside.The procedures of partial nephrectomy were performed according to the conventional steps.Renal reconstruction was done by the 2-0V-loc barbed suture using the knotless closure technique.Results The procedure of partial nephrectomy was successfully performed in 2cases,with the operation time being 100and 102min,the docking time being 7and 11min,and the time periods of warm ischemia being 23and 28min.The V-loc barbed suture was used to close the defect of kidney without bleeding after unclamping the renal artery.Conclusion This novel Spider LESS platform is safe and feasible for partial nephrectomy in pigs,which better solves the problem of"cross manipulation"in single-port laparoscopy,avoiding external instrument clashing;but it still has many drawbacks like the lack of strength and precise maneuverability of the tips,which may hamper the visual field in the operation.

Transumbilical laparoendoscopic single-site surgery(LESS) partial nephrectomy: a median follow-up of 2 years

ObjectiveNephron-sparing surgery (NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery. Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis; LESS is developing quickly and its indications have been expanded, but still in its infancy. The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy (LESS-PN), so as to assess its utility, safety and efficacy. MethodsFrom August 2009 to October 2010, 3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution. Patient demographics, perioperative and follow-up data were prospectively collected and analyzed. ResultsAll the three procedures were successfully completed. A 5-mm ancillary trocar was utilized in all 3 cases. The mean operative duration was 226.3 (210–254 min) with an estimated blood loss of 56.7 ml (20–100 ml). Mean warm ischemia time was 35.7 min (19–48 min). One patient was transfused due to postoperative bleeding. The recovery was uneventful and mean length of postoperative stay was 13 days (12–14 days). At the latest follow-up, all patients remained symptom-free and had normal renal function without evidence of recurrence, and they were delighted for a hidden transumbilical scar. ConclusionTransumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging. Surgical outcomes at a median follow-up of 2 years are promising, while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.

UP-01.161 Laparo-Endoscopic Single-Site PartialNephrectomy: Report of Two Initial Cases

To report and assess the feasibility and safety of the laparoendoscopic single-site (LESS) partial nephrectomy for a small renal cell carcinoma (RCC) tumor by 2 initial cases recently performed in our centre.

Two-port Robot-assisted vs Standard Robot-assisted Laparoscopic Partial Nephrectomy: A Matched-pair Comparison

To compare the outcomes between 2-port robot-assisted partial nephrectomy (2-portRALPN) and standard robot-assisted laparoscopic partial nephrectomy (sRALPN). From May 2009 to February 2010, 35 2-portRALPN were done by a single surgeon in a university-based tertiary referral center. A cohort of 35 patients who underwent sRALPN from September 2006 to July 2009 was selected for retrospective comparison and matched for tumor complexity. All patients underwent partial nephrectomy (PN) using the daVinci surgical robotic platform (Intuitive Surgical, Sunnyvale, CA). In the 2-portRALPN, a homemade umbilical port and an infraumbilical assistant port were used, whereas standard laparoscopic port placement was used for sRALPN. The clinical, operative, pathologic, and follow-up information were collected. The operative time (187.5 vs 171.7 minutes, P=.110), warm ischemia time (29.5 vs 28.8 minutes, P=.209), blood loss (257 vs 242.5 mL, P=.967), complication rate (17.1 vs 11.4%, P=.495), and transfusion rate (8.6 vs 2.9%, P=.303) were comparable in both groups. The pain scores on the first postoperative day (4.5 vs 3.9, P=.236) and on the day of discharge (2.3 vs 1.9, P=.433), in-hospital morphine requirement (130.5 vs 122.2 mg, P=.115), and length of hospital stay (4.2 vs 4.2 days, P=.875) were likewise similar in both groups. This matched-pair study design comparing 2-portRALPN with sRALPN shows that the outcomes of both techniques are comparable. The 2-portRALPN technique is a viable option until a more advanced robotic platform specifically designed for laparoendoscopic single-site surgery is developed and a pure robot-assisted laparoendoscopic single site surgery PN can be safely performed.

Multicenter Experience with Nonischemic Multiport Laparoscopic and Laparoendoscopic Single-Site Partial Nephrectomy Utilizing Bipolar Radiofrequency Ablation Coagulator

Objective. To investigate feasibility of multiport and laparoendoscopic single-site (LESS) nonischemic laparoscopic partial nephrectomy (NI-LPN) utilizing bipolar radiofrequency coagulator. Methods. Multicenter retrospective review of 60 patients (46 multiport/14 LESS) undergoing NI-LPN between 4/2006 and 9/2009. Multiport and LESS NI-LPN utilized Habib 4X bipolar radiofrequency coagulator to form a hemostatic zone followed by nonischemic tumor excision and renorrhaphy. Demographics, tumor/perioperative characteristics, and outcomes were analyzed. Results. 59/60 (98.3%) successfully underwent NI-LPN. Mean tumor size was 2.35 cm. Mean operative time was 160.0 minutes. Mean estimated blood loss was 131.4 mL. Preoperative/postoperative creatinine (mg/dL) was 1.02/1.07 (P = .471). All had negative margins. 12 (20%) patients developed complications. 3 (5%) developed urine leaks. No differences between multiport and LESS-PN were noted as regards demographics, tumor size, outcomes, and complications. Conclusion. Initial experience demonstrates that nonischemic multiport and LESS-PN is safe and efficacious, with excellent short-term preservation of renal function. Long-term data are needed to confirm oncological efficacy.

Transumbilical laparo-endoscopic single-site partial nephrectomy: an initial clinical experience of 2 cases

Objective To summarize our experience and operative techniques of transumbilical laparo-endoscopic single-site partial nephrectomy (TLSPN).Methods TLSPN was performed on two patients for the right kidneys in August and September of 2009.Results The operation was successfully done in both cases,with an additional trocar of 5 mm to retract the liver.The operation time was 255 min and 240 min; the time periods of renal artery occlusion were 48 min and 40 min; and the intraoperative blood losses were 100 ml and 50 ml.None of the patients received blood transfusion or antalgic.The drainage was removed 9 days and 5 days after operation,and the postoperative hospital stays were 13 and 12 days.Conclusion TLSPN is a safe and effective method with less trauma.However,special instruments are needed for the procedure,and the suture and knotting are somewhat difficult.An assistant trocar is needed for the procedure for the right kidney.

Feasibility of Laparoendoscopic Single-Site Partial Nephrectomy in a Porcine Model

PurposeWe performed laparoendoscopic single-site (LESS) partial nephrectomy in a porcine model with the objectives of overcoming the technical challenges of this surgery and exploring its feasibility.Materials and MethodsSix partial nephrectomies were performed on a pig aged 5 months, three cases on each kidney, by four surgeons: two urologists with much experience in laparoscopic surgery (E1, E2) and two less-experienced urologists (B1, B2). While under general anesthesia, the swine was placed in a lateral flank position. Umbilical placement of an Octoport was done with a 2.5 cm incision. After dissection of the renal hilum and Gerota's fascia, a bulldog clamp was applied on the renal artery and parenchymal resection was done. Renorrhaphy was then performed with interrupted sutures with the use of a sliding knot technique.ResultsAll six partial nephrectomies were performed successfully after repair of the vascular and collecting system at the resection margin and renorrhaphy without the need to introduce any additional ports. There were no noticeable intra- or postoperative complications. The mean warm ischemic time was 42 minutes (range, 30-60 minutes). The shortest warm ischemic time, 30 minutes, was achieved by using the early unclamping technique during renorrhaphy. The longest warm ischemic time was 60 minutes. The average number of renorrhaphy stitches was 3.2 (range, 2-5).ConclusionsLESS partial nephrectomy was successfully performed in a porcine model but resulted in a longer ischemic time than that of conventional laparoscopic surgeries. Therefore, further laboratory disciplinary efforts are needed to decrease the warm ischemic time and to improve this surgical technique.

Current Status of Partial Nephrectomy for Renal Mass

The standard treatment for a small mass has shifted from radical nephrectomy to partial nephrectomy. The benefits of partial nephrectomy, including preserving renal function, prolonging overall survival, preventing postoperative chronic kidney disease, and reducing cardiovascular events, have been discussed in many studies. With the accumulation of surgeons' experience and simplification of the operative procedures, the warm ischemic time has become shorter despite the indication of tumor size becoming larger. With the help of intraoperative ultrasound, partial nephrectomy can be performed for an endophytic renal mass. Recently, laparoscopic partial nephrectomy has become well indicated for most renal tumors in many centers with advanced laparoscopic expertise. Open partial nephrectomy remains indicated for complex tumors. With technical innovation, robotic partial nephrectomy shows at least comparable perioperative outcomes with a benefit for challenging cases. Laparoendoscopic single-site partial nephrectomy has recently been tried in limited indications and seems to be feasible.

Editorial Comment

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

Pediatric Laparoendoscopic Single-site Partial Nephrectomy: Initial Report

We present a case of transumbilical laparoendoscopic single-site surgery (LESS) for partial nephrectomy in a child. On May 22, 2009, we performed LESS partial nephrectomy on a 7-year-old girl with a 3.5-cm renal mass. The surgery was performed using a homemade single-port device inserted through a single 3-cm umbilical incision. LESS partial nephrectomy was performed with hilar clamping and suturing of the renal defect. The duration of the operation was 210 minutes, and the warm ischemic time was 42 minutes. The suturing required 35 minutes, and the estimated blood loss was 10 mL. Histopathological analysis revealed a 3.5-cm metanephric adenoma with a clean surgical margin. The patient was discharged without intraoperative or postoperative complications. On follow-up, Doppler ultrasound sonography showed the kidney was normal in appearance, size, and echogenicity. Split renal function was calculated to be 47.5% for the left kidney upon dimercaptosuccinic acid renal scintigraphy. LESS partial nephrectomy was safe and feasible for removal of a renal mass in a child. Additional development of applicable instruments and refinement of the suturing technique are needed.

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 ...