Single-site Surgery In Urology Research Articles

Editorial Comment

Laparoendoscopic single site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES) emerged as promising techniques that aim to continue evolution of minimally invasive surgery by attempting to further reduce pain and improve cosmesis of multiport laparoscopy. Recently there seems to be a relative waning of the otherwise heightened enthusiasm with these procedures just a few years ago. LESS/NOTES are still remaining procedures performed by experienced experts in referral centers, used more frequently for extirpative procedures in carefully selected patients. 1 Merseburger A.S. Herrmann T.R. Shariat S.F. et al. EAU guidelines on robotic and single-site surgery in urology. Eur Urol. 2013; 64: 277-291 Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar Although there has been improvement to the design of the instruments (longer, prebent and articulated instruments and cameras) that facilitate LESS/NOTES procedures, they are still relatively laborious with suboptimal ergonomics. Continuing refinement of instrumentation and, most importantly, development of purpose-specific robotic platforms may overcome current limitations of LESS/NOTES due to the lack of the triangulation. These may help wider adoption of LESS/NOTES that remain promising techniques waiting for a suitable technology. Hybrid Transvaginal Nephrectomy: Development of Our TechniqueUrologyVol. 84Issue 1PreviewTo evaluate the development of natural orifice transluminal endoscopic surgery (NOTES) transvaginal nephrectomy and present the initial experience. Full-Text PDF ReplyUrologyVol. 84Issue 1PreviewThe technical difficulty of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal surgery (NOTES) hinders their wide acceptance. The development and adoption of new instrument designs have not yet overcome these technical issues. Even the specially designed LESS instruments for robot-assisted LESS face technical problems.1 Nevertheless, the introduction of the special instrumentation for LESS and NOTES may represent one of the greatest contributions of these approaches to minimally invasive surgery. Full-Text PDF

IJU this issue

In this issue of the journal, we have four Review Articles, six Original Articles, one Short Communication, one Case Report and two Letters to the Editor. I would like to pay close attention to the interesting papers that reported and discussed current topics of prostate cancer. Masuda et al. (Tokyo, Japan) explored the relationship between body mass index (BMI) and prostate cancer risk at biopsy in Japanese men, and compared the risk with that of Caucasian men. They retrospectively evaluated Japanese men with prostate-specific antigen (PSA) levels from 2.5 to 19.9 ng/mL undergoing an initial extended prostate biopsy. There was a significant positive relationship between BMI and prostate cancer risk at biopsy, with an increased risk observed in men whose BMI was ≥27.0, compared with the reference group. A significantly increased risk starting at BMI ≥25.0 was found in high-grade disease. In contrast to their results, there has been no reported increase in the risk of prostate cancer at biopsy in Caucasians within the overweight range (BMI of 25.0–29.9). The authors concluded that Japanese men within the overweight BMI range who have an elevated PSA also have a significant risk of harboring prostate cancer, especially high-grade disease, and that overweight Japanese might be at greater prostate cancer risk at biopsy than overweight Caucasians. The accuracy of the Japan Cancer of the Prostate Risk Assessment (J-CAPRA) score, which was developed as a risk stratification instrument for patients undergoing primary androgen deprivation therapy, was externally validated for predicting cause-specific survival (CSS) among patients in the USA community-based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry; however, there have been no investigations to validate the accuracy of the J-CAPRA score in predicting progression-free survival (PFS) along with analysis of clinical situation. Kitagawa et al. (Kanazawa, Japan) examined whether the clinical outcomes of patients treated by combined androgen blockade (CAB) with bicalutamide could be stratified using the J-CAPRA score. The factors used in the J-CAPRA points were significant predictors of PFS, and clinical T stage and M stage were also significant predictors of PFS. The probabilities of PFS and CSS were significantly different among the groups categorized according to the J-CAPRA risk strata. The authors concluded that the J-CAPRA score is a useful tool for predicting the clinical outcomes of patients with prostate cancer treated by CAB including bicalutamide. Several papers of laparoendoscopic single-site surgery in urology have been published, but just a few cases of radical prostatectomy have been reported. Nakane et al. (Anjo, Japan) showed the early outcomes of an original two-port laparoendoscopic approach for radical prostatectomy. A multichannel port with three 5-mm trocars, providing easier instrument handling, was inserted extraperitoneally through a 2.5-cm lower umbilical “U” incision. An additional 12-mm port was inserted into the left fossa to allow an adequate working angle. The operation was successfully completed in all 22 patients with early-stage prostate cancer; only one patient required an additional 5-mm port to control bleeding. There were no intraoperative complications. The authors concluded that this new procedure can be safely carried out if the surgeon is familiar with conventional five-port laparoscopic radical prostatectomy. Paraneoplastic limbic encephalitis (PLE) is a rare tumor-related syndrome, and the prognosis for neurological recovery and survival is poor. The neoplasms most frequently associated with PLE are small cell lung cancer and testicular cancer. Jakobsen et al. (Viborg, Denmark) reported a rare case of prostate cancer-related PLE. The authors showed that high-risk prostate cancer can trigger PLE, a rapidly progressive neurological syndrome with a bad prognosis. None declared.

Current state of single-port transumbilical surgery in urology: Challenges and applications

ContextLaparoscopic surgery in urology is considered to be an important advance, although it is not exempt from some morbidity associated to the use of multiple trocars and specifically to the extraction of the specimen. In order to decrease this morbidity and improve esthetics, other techniques are being developed, such as natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). It is aimed to review the current status of laparoendoscopic single site surgery in urology. Acquisition of evidenceA nonsystematic review has been carried out by means of the bibliographic search using the terms LESS and Urology from 2007 to 2012. The current LESS experience in urology is described, and its principal indications and the different single site devices and instruments available on the market are described. Synthesis of evidenceLESS surgery arose as one more step in the constant evolution of minimally invasive surgery in an attempt to improve esthetics, reduce surgical trauma and decrease pain and the post-operative complications associated to the conventional laparoscopy with multiple trocars. Since it was first described in 2007, the experience has been increasing exponentially and the LESS technique, whether assisted or not by robot, is becoming consolidated for a large spectrum of urological indications (both in oncological and reconstructive surgery) on a much greater scale than the NOTES technique. Even though most of the existing data are not randomized and very rarely comparative, with the selection bias that this represents, it seems clear that the esthetic benefit and analgesic control associated to the LESS surgery is real and reproducible. The complications associated to it are greater in cases of major oncology surgery and are due more to the technique itself then to the approach. ConclusionsAlthough the real benefit of the LESS surgery in urology cannot be appropriately quantified, the cosmetic improvement, less pain and greater patient satisfaction with their wound are clear. Appropriate training in this type of procedures in centers having large volumes and the continuous technical improvements in the instrumental development by the biomedical industry has resulted in the fact that the transumbilical LESS technique in urology has been born to stay.

Complications of laparo-endoscopic single-site surgery in urology

The objective was to give a general overview of common complications and rates reported in the current literature during performance of a variety of urologic procedures using laparo-endoscopic single-site surgery or LESS. A search of published reports using Pubmed and MEDLINE was performed with the following search terms: laparo-endoscopic single-site surgery, LESS or laparo-endoscopic single-site surgery complications within the date range of 2005--2011. Studies that were deemed appropriate and relevant to the current symposium were chosen for review. Overall complication rates were reported as ranging between 10% and 25%. In general, reconstructive procedures had consistently higher rates of complications than their extirpative/ablative counterparts (27% vs. 8%). There remain insufficient data to comment on differences in the rates or types of complications related to variations in the approach (transperitoneal vs. retroperitoneal), site of surgery (upper tract vs. lower tract) or specific technique used (instruments, access devices, robotic platforms, etc.). Complication rates associated with LESS in urology appear only slightly higher than with conventional laparoscopy. However, with proper patient selection and careful application of these techniques, proofs of concept and technical feasibility have been shown in several series. There continues to be a need for more standardization of the technique and reporting as well as more collaborative efforts to fully address questions of safety and efficacy of these new procedures.

Analysis of cumulative series of laparoendoscopic single-site surgery in urology : with 209 consecutive cases report

Objective To report a 4-year cumulative series (209 cases) of laparoendoscopic singlesite surgery (LESS) in urology and assess its clinical utilization. Methods Consecutive LESS cases done between December 2008 and July 2012 at our institution were prospectively recorded and retrospective analyzed in this study.Demographic data,main perioperative outcomes,and information related to the surgical technique were collected and analyzed.There were 209 patients ( 121 males and 88 females) with a mean age of (52.8 ±14.5) years,a mean B MIof (23.5 ±3.12) kg/m2 and a mean ASA score of (2.0±0.3).20.1％ (42 cases) of patients had previous abdominal or pelvic surgeries.29.2％ (61 cases) and 12.9％(27 cases) of patients had diabetes mellitus and hypertension. Indications were renal tumors (70 cases,33.5％),adrenal tumors (42,20.1％),renal cyst (22 cases,10.5％),ureteral calculi (22 cases,10.5％),nonfunctional kidneys (19 cases,9.1％),BPH (10 cases,4.8％),and others (24 cases,11.5％ ).Surgical conversions were evaluated,as well as intraoperative and postoperative complications.Two periods were arbitrarily dcfined:the first was from December 2008 to Septcmber 2010 (22 mon) and the second.was from October 2010 to July 2012 (22 mon).A comparative analysis between these two periods was conducted. Results There were 209 LESS surgeries included in this study.Most common procedures ( 92.3％ ) were done on the upper urinary tract,with 55.5％ of the whole cohort being tumor-related indications and only 16.3％ being reconstructive procedures.The transperitoneal approaches were preferentially adopted in 80.9％ cases,and transvesical access in 5.3％ cases. The transumbilical access was used in 46.9％ of cases.The overall conversion rate was 8.1％,with 4.3％ of cases converted to reduced - port laparoscopy,1.9％ to conventional laparoscopy,and 1.9％ to open surgery.The intraoperative complication rate was 4.8％ ( 10/209 ) and postoperative complications,mostly low grade,were encountered in 11.5％(24/209) of cases.There was a significant increase in the number of LESS cases during the second study period; the rate of some procedures (ie,transumbilical LESS,renal cyst decortication and transvesical single-port enucleation of the prostate) was lower,whereas some other procedures were performed more frequently (ie,tumor-related LESS procedures,radical nephrectomy and adrenalectomy). Conclusions A broad range of urological procedures can be finished with LESS technique in the experienced hands of a laparoscopic surgeons.However,LESS is still in its infancy with a certain risk of surgical complication and conversion.Stringent patient selection criteria should be applied,especially during the learning curve.Complex reconstructive procedures or malignant tumor related indications are not appropriate as the start of this kind of procedure.We need always put patient's safety and treatment efficacy first. Key words: Laparoendoscopic single-site surgery; Laparoscopy; Urologic surgery

Estado actual de la cirugía transumbilical por puerto único en urología: retos y aplicaciones

ContextLaparoscopic surgery in urology is considered to be an important advance, although it is not exempt from some morbidity associated to the use of multiple trocars and specifically to the extraction of the specimen. In order to decrease this morbidity and improve esthetics, other techniques are being developed, such as natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). It is aimed to review the current status of laparoendoscopic single site surgery in urology. Acquisition of evidenceA nonsystematic review has been carried out by means of the bibliographic search using the terms LESS and Urology from 2007 to 2012. The current LESS experience in urology is described, and its principal indications and the different single site devices and instruments available on the market are described. Synthesis of evidenceLESS surgery arose as one more step in the constant evolution of minimally invasive surgery in an attempt to improve esthetics, reduce surgical trauma and decrease pain and the post-operative complications associated to the conventional laparoscopy with multiple trocars. Since it was first described in 2007, the experience has been increasing exponentially and the LESS technique, whether assisted or not by robot, is becoming consolidated for a large spectrum of urological indications (both in oncological and reconstructive surgery) on a much greater scale than the NOTES technique. Even though most of the existing data are not randomized and very rarely comparative, with the selection bias that this represents, it seems clear that the esthetic benefit and analgesic control associated to the LESS surgery is real and reproducible. The complications associated to it are greater in cases of major oncology surgery and are due more to the technique itself then to the approach. ConclusionsAlthough the real benefit of the LESS surgery in urology cannot be appropriately quantified, the cosmetic improvement, less pain and greater patient satisfaction with their wound are clear. Appropriate training in this type of procedures in centers having large volumes and the continuous technical improvements in the instrumental development by the biomedical industry has resulted in the fact that the transumbilical LESS technique in urology has been born to stay.

Initial experience of transumbilical laparoendoscopic single-site surgery in urology

Objective To summarize the initial experience of transumbilical laparoendoscopic single-site surgery of urology. Methods From February 2010 to March 2011,21 patients underwent laparoendoscopic single-site surgery using transumbilical single-site and common surgical instruments of laparoendoscopic.Nine patients underwent single-site laparoscopic ureterolithotomy,5 underwent transumbilical single-site laparoscopic ureteral stricture resection and anastomosis,5 underwent transumbilical single-site laparoscopic renalcyst unroofing and 2 had a nephrectomy.All of the cases were definitely diagnosed.A single umbilical incision of 1.5 cm to 2.5 cm was made for Triport.The procedures were performed according to the methods used in classical laparoscope methods using general instruments. Results All the operations were successfully completed without conversion to open surgery.The mean operative time of ureterolithotomy was 143 (120-230) min,the mean operative time of ureteral stricture resection and anastomosis was 157 (120 -180) min,the mean operative time of unroofing of renal cysts was 110 (95 -132) min,and the operative time of the nephrectomy was from 95 to 120 min.The intestinal tract function recovered within 1 -2 d,the drainage tube was removed within 2 -3 d and the postoperative hospitalization duration was 4 -7 d.The symptoms were reduced or disappeared and no major intraoperative or postoperative complications occurred within 4 - 6 months. Conclusions Transumbilical laparoendoscopic single-site surgery represents a safe and feasible operation for urologic patients.With more clinical practice,laparoendoscopic single-site surgery could be generally applied. Key words: Laparoscopes; Transumbilical; Single-site; Conventional laparoscopic instruments; Surgery

Laparoendoscopic single site surgery in urology: A single centre experience

OBJECTIVE:To analyze our experience of 87 cases with single port surgery, which is also known as laparoendoscopic single site surgery (LESS).MATERIALS AND METHODS:Case records of all LESS procedures performed between December 2007 and June 2010 were analysed. The procedures performed were donor nephrectomy (n=45), simple nephrectomy (n=27), radical nephrectomy (n=5), pyeloplasty (n=9), and ureteroneocystostomy (n=1). Parameters analysed were operating room (OR) time, estimated blood loss (EBL), visual analogue score (VAS), and complications in all patients undergoing LESS procedure and additionally, warm ischaemia time (WIT) and graft outcome in patients undergoing LESS donor nephrectomy. In reconstructive procedures, the functional assessment was performed with a diuretic renogram at 6 months.RESULTS:In LESS donor nephrectomy, the mean WIT was 6.9 ± 1.9 min. Mean serum creatinine in recipients at 1 month was 0.96 ± 0.21 mg%. We encountered one instance each of renal artery injury, renal vein injury, large bowel injury, minor cortical laceration at the upper pole and two instances of diaphragmatic injury. In LESS simple nephrectomy, the average OR time was 148.7 ± 52.2 min and hospital stay was 3.7 ± 1.2 days. There was one instance of large bowel injury during specimen retrieval. In LESS radical nephrectomy, the average OR time was 202.5 ± 35.7 min and average hospital stay was 4.2 ± 1.3 days. 6 patients of LESS pyeloplasty completed follow up with a diuretic renogram showing a good drainage. LESS ureteroneocystostomy could also be performed successfully without any complications.CONCLUSION:LESS surgery can be accomplished safely in nephrectomy and reconstructive procedures such as pyeloplasty and ureteroneocystostomy with equivalent outcomes as standard laparoscopy and with added benefits of cosmesis and quicker convalescence. LESS donor nephrectomy is a technically feasible procedure; current status of procedure needs to be proved with randomised controlled studies.

Laparoendoscopic single-site surgery in urology: a single-center experience

Objective To present our experience on the first 100 cases receiving urological laparoendoscopic single-site surgery(LESS).Methods Between Dec.2008 and May 2011,a cohort of 98patients received a total of 100TriPort TM LESS urologic surgeries for various indications,including 2patients undergoing bilateral surgeries.The proceducres included radical nephrectomy(n=24),partial nephrectomy(n=3),simple nephrectomy(n=10),kidney cyst excision(n=21),adrenlectomy(n=12),transvesical simple prostatectomy(n=9),ureterolithotomy(n=6),and others(n=15).The demographics,perioperative outcomes,and follow-up data were prospectively analyzed.Results Of the 100surgeries,87were smoothly completed.A 5mm ancillary trocar was required in 9cases.Conversion to standard laparoscopy and open surgery were needed in 1and 3patients,respectively.The overall complication rate was 15%,with 6%intraoperatively and 9% postoperatively.The complication rate was 5%for the first 50cases and 10%for the second 50cases.The patients were followed up for 9.9± 5.61(ranging 3-24)months.At the latest follow-up,all patients remained clinically healthy with a delightedly hidden scar.No evidence of recurrence or metastasis was detected in patients receiving tumor resection.Conclusion The LESS is safe and technically feasible for urological surgery,with minimal invasiveness and better cosmesis.Emphasis should be made on patient selection and indication criteria.Improvement in instrumentation,accumulation of clinical practice,and well-designed multicenter prospective clinical trials will promote the use of LESS surgery for treatment of urologic diseases.

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.

Laparo-Endoscopic Single Site Anatomical Retroperitoneoscopic Adrenalectomy Using Conventional Instruments: Initial Experience and Short-Term Outcome

To our knowledge we present the initial experience with and the short-term outcome of laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments. Between June 2009 and April 2010, 25 patients underwent laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy. A TriPort™ Access System was inserted through a 2.5 to 3.0 cm transverse skin incision below the tip of the 12th rib. Adrenalectomy was done using a 5 mm 30-degree laparoscopic camera and 2 conventional laparoscopic instruments. After Gerota's fascia was incised we explored the first dissection plane between the perirenal fat and the anterior renal fascia at the superomedial side of the kidney. The adrenal gland was identified at the initial stage of the operation. Laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy was successfully accomplished in 23 patients. An additional 5 mm port was required in 1 of the 2 unsuccessful cases and in the other it was necessary to convert to standard anatomical retroperitoneoscopic adrenalectomy. Median incision length was 3.0 cm, median operative time was 55 minutes and median estimated blood loss was 15 ml. No major intraoperative complications occurred. In the initial 10 cases median operative time was significantly longer (62 vs 50 minutes) and median blood loss was significantly higher (75 vs 10, each p <0.001) than in the subsequent 15. In 3 cases pheochromocytoma was successfully excised without undesirable hemodynamic oscillation. Postoperative complications developed in 2 patients, including angina and contralateral atelectasis in 1 each. In properly selected patients laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy with conventional instruments is feasible, safe and effective, causes minimal morbidity and results in excellent cosmesis.

Laparoendoscopic single-site surgery in urology

To analyze the current literature regarding advances in laparoscopic single-site (LESS) surgery in urology. Since its initial urologic description in 2007, there has been a surge of interest in LESS surgery. Published descriptions of LESS procedures now include virtually all extirpative and reconstructive urologic procedures. Novel instrumentation and techniques have been developed that offset many of the inherent increased technical demands with LESS surgery. Substantial clinical data have recently been reported that attest to the safety and efficacy of LESS surgery in select patients. Initial data have also been reported comparing morbidity outcomes with standard laparoscopy. LESS is now an established technique within the field of minimally invasive urologic surgery. Further study is needed to determine the true benefits of the technique and the extent of its clinical application. Further refinements in technology will likely be needed before the widespread adoption of LESS.

Laparoendoscopic single-site surgery in urology

Since its introduction, the role of laparoscopic surgery has grown and it has now become the standard approach for many surgical procedures. The benefits of smaller incisions, improved pain and convalescence, and shorter hospital stays have greatly improved patient care and satisfaction. In an effort to further minimize the morbidity of surgery, laparoendoscopic single-site (LESS) or single-incision laparoscopic surgery (SILS) has emerged. We review the collective experience with this novel technique and share our initial observations and early results. We performed a literature search to review the published experience with this new technique including the breadth of applications and perioperative outcomes associated with LESS in urology. We also analysed the experience with this emerging technique at our institution. There are numerous variations with regards to nomenclature as well as types of access to the abdominal cavity as it pertains to LESS. Urologic procedures involving single-port access have acceptable operating room time, blood loss, and postoperative pain, which are in line with standard laparoscopic surgical outcomes with the added benefit of improved cosmesis and smaller incisions. Further studies and larger cohorts are needed to assess the real benefit of LESS procedures. The additional learning curve needed to master these techniques may be a barrier to wider acceptance, although improvements in instrumentation are likely to bridge this gap.

LAPARO‐ENDOSCOPIC SINGLE‐SITE SURGERY IN UROLOGY: IS ROBOTICS THE MISSING LINK?

BJU InternationalVolume 104, Issue 8 p. 1041-1043 LAPARO-ENDOSCOPIC SINGLE-SITE SURGERY IN UROLOGY: IS ROBOTICS THE MISSING LINK? Abhay Rané, Abhay Rané Department of Urology, East Surrey Hospital, Redhill, UK, Brady Foundation Department of Urology, Weill Medical College of Cornell University, andSearch for more papers by this authorGerald Y. Tan, Gerald Y. Tan Department of Urology, East Surrey Hospital, Redhill, UK, Brady Foundation Department of Urology, Weill Medical College of Cornell University, and Lefrak Institute of Robotic Surgery, New York Presbyterian Hospital, New York, NY, USASearch for more papers by this authorAshutosh K. Tewari, Corresponding Author Ashutosh K. Tewari Department of Urology, East Surrey Hospital, Redhill, UK, Brady Foundation Department of Urology, Weill Medical College of Cornell University, and Lefrak Institute of Robotic Surgery, New York Presbyterian Hospital, New York, NY, USAAshutosh K. Tewari, Brady Foundation Department of Urology, Weill Medical College of Cornell University, 525 East 68th Street, Starr 900, New York, NY 10065, USA.e-mail: [email protected]Search for more papers by this author Abhay Rané, Abhay Rané Department of Urology, East Surrey Hospital, Redhill, UK, Brady Foundation Department of Urology, Weill Medical College of Cornell University, andSearch for more papers by this authorGerald Y. Tan, Gerald Y. Tan Department of Urology, East Surrey Hospital, Redhill, UK, Brady Foundation Department of Urology, Weill Medical College of Cornell University, and Lefrak Institute of Robotic Surgery, New York Presbyterian Hospital, New York, NY, USASearch for more papers by this authorAshutosh K. Tewari, Corresponding Author Ashutosh K. Tewari Department of Urology, East Surrey Hospital, Redhill, UK, Brady Foundation Department of Urology, Weill Medical College of Cornell University, and Lefrak Institute of Robotic Surgery, New York Presbyterian Hospital, New York, NY, USAAshutosh K. Tewari, Brady Foundation Department of Urology, Weill Medical College of Cornell University, 525 East 68th Street, Starr 900, New York, NY 10065, USA.e-mail: [email protected]Search for more papers by this author First published: 14 September 2009 https://doi.org/10.1111/j.1464-410X.2009.08480.xCitations: 25Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume104, Issue8October 2009Pages 1041-1043 RelatedInformation

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.

Devices for laparoendoscopic single-site surgery in urology

The quest to make minimally invasive techniques even more ‘minimal’ has generated a drive within the surgical community to explore novel ways of achieving this. This has led to surgeons attempting to either decrease the number of trocars placed through the abdominal wall or eliminate them completely. This led to the evolution of several approaches, including natural orifice translumenal endoscopic surgery (NOTES), single incision laparoscopic surgery (SILS), single port access surgery and one port umbilical surgery (OPUS) or E-NOTES. The most recent consensus on nomenclature involves the term laparoendoscopic single-site surgery (LESS). The transition from multiple port access surgery to single port access surgery represents a paradigm shift in reconstructive and extirpative surgery and is a testament to the recent advances in surgical technology. Successful LESS involves the use of articulating or bent instrumentation via a single large-caliber trocar or small, adjacent trocars. Advances in technology have led to the development of new laparoscopic access ports (R-Port™ and Quadriport™ by Advanced Surgical Concepts, Wicklow, Ireland; and Uni-X™ Single Port, PNavel Systems, Cleveland, OH, USA) capable of permitting several instruments to be inserted through multiple channels incorporated in, and as part of, a larger single port. The development of articulating and bent instrumentation permits triangulation intracorporeally despite the close proximity of several instruments via a single port. Currently, commercially available instruments can be broadly divided into articulating laparoscopic graspers and shears (Real Hand™, Novare Surgical Systems, Cupertino, CA, USA; and Autonomy Laparo-angle™, Cambridge Endo, Framingham, MA, USA), endoshears (Cambridge Endo), and laparoscopic needle drivers (Cambridge Endo). Despite the preliminary optimistic results in the outcomes of LESS, an experienced laparoscopic skill set is essential for the safe and effective completion of surgery.

Laparoendoscopic single-site surgery in urology: where have we been and where are we heading?

One-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, urologists have successfully performed various procedures with LESS, including partial nephrectomy, pyeloplasty, orchiectomy, orchiopexy, ureterolithotomy, sacrocolpopexy, renal biopsy, renal cryotherapy, and adrenalectomy. Further advancements in technology, such as magnetic anchoring and guidance systems, and robotic instrumentation, may allow broader application of this emerging surgical technique. Future research is required to determine the intraoperative and postoperative benefits of LESS in comparison with standard laparoscopy.

Basic Research Symposium

Journal of EndourologyVol. 21, No. supplement 1 Basic Research SymposiumBasic Research SymposiumPublished Online:23 Oct 2007https://doi.org/10.1089/end.2007.WCE03AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited bySite of impaction of ureteric calculi requiring surgical intervention22 September 2013 | Urolithiasis, Vol. 42, No. 1Natural orifice transendoluminal surgery and laparoendoscopic single-site surgery: the future of laparoscopic radical prostatectomyFuture Oncology, Vol. 7, No. 3Laparoendoscopic single-site surgery in urology: where have we been and where are we heading?Nature Clinical Practice Urology, Vol. 5, No. 10 Volume 21Issue supplement 1Oct 2007 InformationMary Ann Liebert, Inc.To cite this article:Basic Research Symposium.Journal of Endourology.Oct 2007.A1-A292.http://doi.org/10.1089/end.2007.WCE03Published in Volume: 21 Issue supplement 1: October 23, 2007PDF download