Technical pearls of retroperitoneal laparoendoscopic single site nephrectomy

Czech version

Authors: S-C J. Chueh; S.-D. Chung; Y.-C. Tsai
Authors‘ workplace: Cleveland Clinic Urology Charleston Office
Published in: Urol List 2012; 10(2): 31-37

Overview

Laparoendoscopic single site surgery (LESS) is an advanced form of laparoscopic surgery that allows for the performance of major urologic procedures via just a single small incision. Most published series utilized transperitoneal approach. Kidneys are located in the retroperitoneal space. Nephrectomy via the retroperitoneoscopic approach carries certain advantages: no violation of the peritoneal cavity and the intraperitoneal organs, avoiding existing intra-abdominal adhesions, and more direct access to the renal artery, and upper pole, etc. We had performed series of successful retroperitoneal LESS nephrectomy, and have had proved its feasibility and safety. In this article we will demonstrate our step-by-step approach of retroperitoneal LESS nephrectomy, and discuss its tips, tricks, and limitations. Contraindications to this approach include severely inflamed and fibrotic xanthogranulomatous pyelonephritis, and large renal tumors with venous tumor thrombi or tumors located anteriorly abutting the parietal peritoneum.

Key words:
laparoscopy, laparoendoscopic single site surgery, triangulation, nephrectomy, trans-peritoneal, retroperitoneum

Sources

1. Kommu SS, Kaouk JH, Rané A. Laparo-endoscopic single-site surgery: preliminary advances in renal surgery. BJU Int 2009; 103(8): 1034–1037.

2. Raman JD, Bensalah K, Bagrodia A et al. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 2007; 70(6): 1039–1042.

3. Rané A, Rao P, Rao P. Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-Port). Urology 2008; 72(2): 260–264.

4. Chueh SC, Sankari BR, Chung SD et al. Feasibility and safety of retroperitoneoscopic laparoendoscopic single-site nephrectomy: technique and early outcomes. BJU Int 2011; 108(11): 1879–1885.

5. Chung SD, Huang CY, Tsai YC et al. Retroperitoneoscopic laparo-endoscopic single-site radical nephrectomy (RLESS-RN): initial experience with a homemade port. World J Surg Oncol 2011; 28(9): 138.

6. Gill IS, Advincula AP, Aron M et al. Consensus statement of the consortium for laparoendoscopic single--site surgery. Surg Endosc 2010; 24(4): 762–768.

7. Pini G, Rassweiler J. Minilaparoscopy and laparoendoscopic single-site surgery: mini- and single-scar in urology. Minim Invasive Ther Allied Technol 2012; 21(1): 8–25.

8. Sankari BR, Chueh SC. Simultaneous laparoendoscopic single-site radical nephrectomy for native kidney and open nonischemic partial nephrectomy to treat concomitant renal cell carcinomas in native and transplant kidneys and to preserve allograft function. Urology 2012; 79(1): 139–144.

9. 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(5): 1198–1204.

10. Stolzenburg JU, Hellawell G, Kallidonis P et al. Laparoendoscopic single-site surgery: early experience with tumor nephrectomy. J Endourol 2009; 23(8): 1287–1292.

11. White WM, Haber GP, Goel RK et al. Single-port urological surgery: single-center experience with the first 100 cases. Urology 2009; 74(4): 801–804.

12. Jeon HG, Jeong W, Oh CK et al. Initial experience with 50 laparoendoscopic single site surgeries using a homemade, single port device at a single center. J Urol 2010; 183(5): 1866–1871.

13. Ryu DS, Park WJ, Oh TH. Retroperitoneal laparoendoscopic single-site surgery in urology: initial experience. J Endourol 2009; 23(11): 1857–1862.

14. White WM, Goel RK, Kaouk JH. Single-port laparoscopic retroperitoneal surgery: initial operative experience and comparative outcomes. Urology 2009; 73(6): 1279–1282.

15. Walz MK, Groeben H, Alesina PF. Single-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case-control study World J Surg 2010; 34(6): 1386–1390.

16. Tsai YC, Ho CH, Tai HC. Laparoendoscopic single-site (LESS) retroperitoneal nephropexy with standard laparoscopic instruments. J Laparoendosc Adv Surg Tech A 2010; 20(3): 257–260.

17. Gaur DD, Agarwal DK, Purohit KC. Retroperitoneal laparoscopic nephrectomy: initial case report. J Urol 1993; 149(1): 103–105.

18. Gill IS, Clayman RV, Albala DM et al. Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective. Urology 1998; 52(4): 566–571.

19. Greco F, Wagner S, Hoda MR et al Single-portal access laparoscopic radical nephrectomy for renal cell carcinoma in transplant patients: the first experience. Eur Urol 2011; 59(6): 1060–1064.

20. Chueh S, Chung S, Tsai Y et al. Tips and tricks of urological laparoendoscopic single site surgery. Recent Advances in Endourology 2012 [accepted, in press].