Laparoendoscopic single-site surgery (LESS) in urology – a new frontier in minimally invasive surgery?
Authors:
Viktor Eret 1; Marek Schmidt 2; Petr Stránský 1; Ivan Trávníček 1; Olga Dolejšová 1; Milan Hora 1
Authors‘ workplace:
Urologická klinika LF UK a FN, Plzeň
1; Urologická klinika 2. LF UK a FN Motol, Praha
2
Published in:
Ces Urol 2012; 16(3): 146-156
Category:
Review article
Overview
Aim:
The objective of this article is to present the recent development and literature rewiev on laparoendoscopic single-site surgery (LESS) in urology.
Method:
In 2007 studies were published using small cohorts and were plagued by technical problems such as insufficient instruments and ports. To advance the technique of minimally invasive laparoscopy further development of new adapted instrumentation (multiluminal ports, flexibile and pre-bent instruments, modified optics) was needed. Currently a large number of new accessories for LESS technique is available. The LESS procedures are most commonly performed on the upper urinary tract. These include radical nephrectomy, renal cyst ablation and simple nephrectomy for non-functional kidney.
Conclusion:
LESS represents an advancement in minimally invasive urological surgery. It has proven to be a feasible and safe method used in a broad range of procedures. LESS is indicated for selected patients with a low body mass index and in cases where a small specimen is extracted. A successful procedure requires an experienced laparoscopic surgeon and assistant. Prospective multicenter clinical studies comparing LESS with conventional laparoscopy are necessary to establish the benefits of this procedure and to evaluate indication criteria.
Key words:
laparoendoscopic single-site surgery, conventional laparoscopy, single port, urology.
Sources
1. Canes D, Desai MM, Aron M, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol 2008; 54: 1020–1030.
2. Fahlenkamp D, Rassweiler J, Fornara P, et al. Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol 1999; 162(3 Pt 1): 765–770; discussion 770–771.
3. Gill IS, Advincula AP, Aron M, et al. Consensus statement of the consortium for laparo-endoscopic single-site (LESS) surgery. Surg Endosc 2010; 24: 762–768.
4. Wheeless CR. A rapid, interexpensive and effective method of surgical sterilization by laparoscopy. J Repris Med 1969; 3(5); 65–69.
5. Pelosi MA, Pelosi MA, Jr. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med 1991; 88: 721–726.
6. Raman JD, Bensalah K, Bagrodia A, et al. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 2007; 70: 1039–1042.
7. Boylu U, Oommen M, Thomas R, Lee BR. Transumbilical single-port laparoscopic partial nephrectomy in a pig model. BJU Int 2010; 105(5): 686–690. Epub 2009 Nov 12.
8. Rane A, Kommu S, Eddy B, et al. Clinical evaluation of a novel laparoscopic port (R-port) and evolution of the single laparoscopic port procedure (SLiPP). J Endourol 2007; 21 (Suppl 1): A22–23.
9. Desai MM, Rao PP, Aron M, et al. Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU 2008; 101: 83–88.
10. Kaouk JH, Haber GP, Goel RK, et al. Single-port laparoscopic surgery in urology: initial experience. Urology 2008; 71: 3–6.
11. Tai HC, Lin CD, Wu CC, et al. Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS). Surg Endosc. 2010; 24(3): 705–708. Epub 2009 Jul 16.
12. Lee SY, Kim YT, Park HY, et al. Initial Experience with Laparoendoscopic Single-Site Surgery by Use of a Homemade Transumbilical Port in Urology. Korean J Urol 2010; 51: 613–618.
13. Goel RK, Kaouk JH. Single port access renal cryoablation (SPARC): a new approach. Eur Urol 2008; 53: 1204–1209.
14. Desai MM, Berger AK, Brandina R, et al. Laparoendoscopic single-site surgery: initial hundred patients. Urology 2009; 74(4): 805–812.
15. Raman JD, Bagrodia A, Cadeddu JA. single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 2009; 55: 1198–1206.
16. Sotelo R, Andrade R, Fernandéz G, et al. NOTES hybrid transvaginal radical nephrectomy for tumor: stepwise progression toward a first successful clinical case. Eur Urol 2010; 57: 138–144.
17. Stolzenburg JU, Kallidonis P, Ragavan N, et al. Clinical outcomes of laparoendoscopic single-site surgery radical nephrectomy. World J Urol 2011 [Epub ahead of print].
18. Aron M, Canes D, Desai MM, et al. Transumbilical single-port laparoscopic partial neprhrectomy. BJU Int. 2008; 103: 516–521.
19. Kaouk JH, Goel RK. Single-port laparoscopic and robotic partial neprhrectomy. Eur Urol 2009; 55: 1163–1170.
20. Gill IS, Canes D, Aron M, et al. Single port transumbilical (E-NOTES) donor nephrectomy. J Urol 2008; 180: 637–641.
21. Ganpule AP, Dhawan DR, Kurie A, et al. Laparoendoscopic single-site donor nephrectomy: a single-centrer experience. Urology 2009; 74: 1238–1240.
22. Musquera M, Peri L, Alcaraz A, et al. Pioneer experience in Spain with LSSS nephrectomy in living donor. Acta Urol Esp 2011; 35(9): 559–562. Epub 2011 Jun 22. Spanish.
23. Cindolo L, Gidaro S, Tamburek FR, et al. Laparo-endoscopic single-site left transperitoneal adrenalectomy. Eur Urol 2010; 57: 911–914. Epub July 2009.
24. Jeong BC, Park YH, Han DH, Kim HH. Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched casecontrol study. J Endourol 2009; 23: 1957–1960.
25. Shi TP, Zhang X, Ma X, et al. Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: a matched-pair comparison with the gold standard Surg Endosc 2011; 25: 2117–2124.
26. Kaouk JH, Goel RK, Haber GP, et al. Single-port laparoscopic radical prostatectomy. Urology 2008; 72: 1190–1193.
27. White MA, Haber GP, Autorino R, et al. Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol 2010; 58: 544–550.
28. Desai MM, Aron M, Canes D, et al. Single-port transvesical simple prostatectomy: initial clinical report. Urology 2008; 72: 960–965.
29. Desai MM, Fareed K, Berger AK, et al. Single-port transvesical enucleation of the prostate: a clinical reporto of 34 cases. BJU Int 2012; 105: 1296–1300.
30. Kaouk JH, Goel RK, White MA, et al. Laparoendoscopic single-site radical cystectomy and pelvic lymph node dissection: initial experience and 2-year follow-up. Urology 2010; 76: 857–861.
31. Autorino R, Kaouk JH, Cadeddu JA, et al. Current status and future directions of robotic single-site surgery: a systematic review. Eur Urol 2012, http://dx.doi.orh/10.1016/j.eururo.2012.08.028c (article in press).
32. Kaouk JH, Goel RK, Haber GP, et al. Robotic single-port transumbilical surgery in humans: initial report. BJU Int 2009; 103: 366–369.
33. Stein RJ, White WM, Goel RK, et al. Robotic laparoendoscopic single-site surgery using GelPort as the Access platform. Eur Urol 2010; 57: 132–137.
34. White MA, Autorino R., Spana G. Robotic Laparoendoscopic Single-Site Radical Nephrectomy: Surgical Technique and Comparative Outcomes. Eur Urol 2011; 59: 815–822.
35. Khanna R, Stein R, White MA, et al. Single institution experience with robot-assisted laparoendoscopic single-site renal procedures. J Endourol 2012; 26(3): 230–234.
36. Kaouk JH, Autorino R, Kim FJ, et al. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol 2011; 10: 998–1005.
37. Sánchez LA, Petroni G, Piccigallo M, et al. Real.-time kontrol and evaluation of a teleoperated miniature arm for single port laparoscopy. Conf Proc IEEE Eng Med Biol Soc 2011; 211: 7049–7053.
38. Dolghi O, Shrabala KW, Oleynikov D. Miniature in vivo robot for laparoscopic singel-site surgery. Surg Endosc 2011; 5: 3453–3458.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2012 Issue 3
Most read in this issue
- Predictive factors for prostate cancer detection using saturation prostate biopsy
- The role of pad tests in evaluation of urinary incontinence
- Non seminoma germ cell tumor (NSGCT) in a non-compliant patient
- The first experience with unilateral barbed suture V-Loc in laparoscopic radical prostatectomy