Technique Of Laparoscopic-Endoscopic Single-Site Surgery Radical Nephrectomy

Main Category: Urology / Nephrology
Article Date: 05 Dec 2009 - 1:00 PDT

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UroToday.com - The development of scarless Laparo-Endoscopic Single Site surgery (LESS) appears to be the next evolutionary step of laparoscopy. In this article we described the technique of LESS radical nephrectomy and we reviewed our experience in a cohort of 10 patients.

The results indicated that LESS nephrectomy is feasible with the use of specially designed instruments. The equipment used was efficient for the safe accomplishment of all cases without the need to conversion to open surgery or to conventional laparoscopy. Nevertheless, in two cases of right nephrectomy, an additional port was deemed necessary in order to offer lateral retraction of the liver. The only part of the procedure not facilitated well by current instrumentation was kidney retrieval at the end of the precedure, since the standard 15-mm Endo-catch bag couldn't be inserted through the TriPort used and, a cumbersome approach was performed for organ retrieval. New specially designed ports or endo-catch bags are expected in order to overcome the above issue. An intraoperative bleeding was the only complication encountered and was successfully managed endoscopically.

Currently, the advantages of LESS over conventional laparoscopy are not yet well documented. The superiority of LESS approach in matters of scar formation and postoperative pain is questionable. Despite the sophisticated flexible/ articulating instruments used, the technical performance of the approach is still considered challenging and time consuming. Significant laparoscopic experience is necessary for the performance of LESS radical nephrectomy. However, LESS should be considered as a further step in minimally invasive surgery. In addition, the use of more advanced instrument designs as well as robotics may improve intraoperative ergonomics to further enhance the benefit of the LESS approach.

Written by Jens-Uwe Stolzenburg1, Panagiotis Kallidonis2, Giles Hellawell3, Minh Do1, Tim Haefner1, Anja Dietel1, and Evangelos N. Liatsikos1,2 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

1 Department of Urology, University of Leipzig, Germany
2 Department of Urology, University of Patras, Greece
3 Department of Urology, Northwick Park Hospital, London, UK

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