Abstract
Introduction
The conventional laparoscopic surgery is now paving way to the new technologies including robotic and laparoscopic single-site surgery (LESS). We present our updated experience on LESS radical nephrectomy (LESS–RN).
Patients and methods
The data from patients undergoing LESS–RN in our two institutions were reviewed along with various clinical and pathological parameters.
Results
Between 2008 and 2011, 42 LESS–RN were performed (right = 22, left = 20) with mean (range) age and BMI of 63.7 (33–86) years and 25.1 (18–38.6) kg/m2, respectively. In addition to the instruments in the single port, one extra 3-mm needlescopic instrument was required in 19 patients (right = 17, left = 2). In three patients, two additional 5-mm trocars and instruments were required. None required open conversion. The recorded adverse events include one bowel injury (intraoperative closure without the need for stoma), one postoperative bleeding requiring blood transfusion, one prolonged ileus, and one deep venous thrombosis. The resected specimens revealed pT1a (n = 3), pT1b (n = 33), pT2a (n = 4), and pT3b (n = 2) tumors. The finding of pT3b was incidental rather than planned procedure. None of the patients had positive margins.
Conclusion
LESS–RN has proven to be feasible and safe. Beyond cosmesis, further advantages of this approach need to be addressed by randomized trials.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fornara P, Doehn C, Friedrich HJ, Jocham D (2001) Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease. Eur Urol 40(1):24–31
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS et al (2010) European association of urology guideline group. 19. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406
Novick AC (2004) Laparoscopic and partial nephrectomy. Clin Cancer Res 10:6322S–6327S
Gill IS, Meraney AM, Schweizer DK, Savage SS, Hobart MG, Sung GT et al (2001) Laparoscopic radical nephrectomy in 100 patients: a single center experience from the United States. Cancer 92:1843–1855
Saika T, Ono Y, Hattori R, Gotoh M, Kamihira O, Yoshikawa Y et al (2003) Long-term outcome of laparoscopic radical nephrectomy for pathologic T1 renal cell carcinoma. Urology 62:1018–1023
Wille AH, Roigas J, Deger S, Tullmann M, Turk I, Loening SA (2004) Laparoscopic radical nephrectomy: techniques, results and oncological outcome in 125 consecutive cases. Eur Urol 45:483–488
Liatsikos E, Kallidonis P, Kyriazis I, Al-Aown A, Stolzenburg JU (2009) Urologic laparoendoscopic single-site surgery. Nat Rev Urol 6(12):654–659
Stolzenburg JU, Kallidonis P, Till H, Burchardt M, Herrmann TR, Liatsikos EN (2009) Current status of laparoendoscopic single-site surgery in urology. World J Urol 27(6):767–773
Stolzenburg JU, Kallidonis P, Hellawell G, Do M, Haefner T, Dietel A, Liatsikos EN (2009) Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur Urol 56(4):644–650
Stolzenburg JU, Kallidonis P, Oh MA, Ghulam N, Do M, Haefner T et al (2010) Comparative assessment of laparoscopic single-site surgery instruments to conventional laparoscopic in laboratory setting. J Endourol 24(2):239–245
Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ et al (2008) Transumbilical single-port surgery: evolution and current status. Eur Urol 54(5):1020–1029
Desai MM, Rao PP, Aron M, Pascal-Haber G, Desai MR, Mishra S et al (2008) Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU Int 101(1):83–88
Rane A, Ahmed S, Kommu SS, Anderson CJ, Rimington PD (2009) Single-port ‘scarless’ laparoscopic nephrectomies: the United Kingdom experience. BJU Int 104(2):230–233
Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA (2007) Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 70(6):1039–1042
Han WK, Park YH, Jeon HG, Jeong W, Rha KH, Choi H et al (2010) The feasibility of laparoendoscopic single-site nephrectomy: initial experience using home-made single-port device. Urology 76(4):862–865
Ponsky LE, Cherullo EE, Sawyer M, Hartke D (2008) Single access site laparoscopic radical nephrectomy: initial clinical experience. J Endourol 22(4):663–666
Ponsky LE, Steinway ML, Lengu IJ, Hartke DM, Vourganti S, Cherullo E (2009) A Pfannenstiel single-site nephrectomy and nephroureterectomy: a practical application of laparoendoscopic single-site surgery. Urology 74(3):482–485
Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D et al (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74(4):805–812
White WM, Haber GP, Goel RK, Crouzet S, Stein RJ, Kaouk JH (2009) Single-port urological surgery: single-center experience with the first 100 cases. Urology 74(4):801–804
Choi KH, Ham WS, Rha KH, Lee JW, Jeon HG, Arkoncel FR et al (2011) Laparoendoscopic single-site surgeries: a single-center experience of 171 consecutive cases. Korean J Urol 52(1):31–38
Raman JD, Bagrodia A, Cadeddu JA (2009) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 55(5):1198–1204
Raybourn JH 3rd, Rane A, Sundaram CP (2010) Laparoendoscopic single-site surgery for nephrectomy as a feasible alternative to traditional laparoscopy. Urology 75(1):100–103
Seo IY, Lee JW, Rim JS (2011) Laparoendoscopic single-site radical nephrectomy: a comparison with conventional laparoscopy. J Endourol 25(3):465–469
Park YH, Park JH, Jeong CW, Kim HH (2010) Comparison of laparoendoscopic single-site radical nephrectomy with conventional laparoscopic radical nephrectomy for localized renal-cell carcinoma. J Endourol 24(6):997–1003
Tugcu V, Ilbey YO, Mutlu B, Tasci AI (2010) Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol 24(8):1315–1320
Kurien A, Rajapurkar S, Sinha L, Mishra S, Ganpule A, Muthu V et al (2011) Standard laparoscopic donor nephrectomy versus laparoendoscopic single-site donor nephrectomy: a randomized comparative study. J Endourol 25(3):365–370
Stolzenburg JU, Hellawell G, Kallidonis P, Do M, Haefner T, Dietel A et al (2009) Laparoendoscopic single-site surgery: early experience with tumor nephrectomy. J Endourol 23:1287–1292
Stolzenburg JU, Do M, Haefner T, Dietel A, Kallidonis P, Kyriazis I et al (2011) Laparoendoscopic single-site surgery radical nephrectomy. J Endourol 25(2):159–165
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stolzenburg, JU., Kallidonis, P., Ragavan, N. et al. Clinical outcomes of laparo-endoscopic single-site surgery radical nephrectomy. World J Urol 30, 589–596 (2012). https://doi.org/10.1007/s00345-011-0765-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-011-0765-1