To report our initial experience with laparoendoscopic single-site (LESS) surgery
in 100 patients in urology.
Between October 2007 and December 2008, we performed LESS urologic procedures in 100
patients for various indications. These included nephrectomy (N = 34; simple 14, radical
3, donor 17), nephroureterectomy (N = 2), partial nephrectomy (N = 6), pyeloplasty
(N = 17), transvesical simple prostatectomy (N = 32), and others (N = 9). Data were
prospectively collected in a database approved by the Institutional Review Board.
All procedures were performed using a novel single-port device (r-Port) and a varying
combination of standard and specialized bent/articulating laparoscopic instruments.
Robotic assistance was used to perform LESS pyeloplasty (N = 2) and simple prostatectomy
(N = 1). In addition to standard perioperative data, we obtained data on postdischarge
analgesia requirements, time to complete convalescence, and time to return to work.
In the study period, LESS procedures accounted for 15% of all laparoscopic cases by
the authors for similar indications. Conversion to standard multiport laparoscopy
was necessary in 3 cases, addition of a single 5-mm port was necessary in 3 cases,
and conversion to open surgery was necessary in 4 cases. On death occurred following
simple prostatectomy in a Jehovah's Witness due to patient refusal to accept transfusion
following hemorrhage. Intra- and postoperative complications occurred in 5 and 9 cases,
respectively. Mean operative time was 145, 230, 236, and 113 minutes and hospital
stay was 2, 2.9, 2, and 3 days for simple nephrectomy, donor nephrectomy, pyeloplasty,
and simple prostatectomy, respectively.
The LESS surgery is technically feasible for a variety of ablative and reconstructive
applications in urology. With proper patient selection, conversion and complications
rates are low. Improvement in instrumentation and technology is likely to expand the
role of LESS in minimally invasive urology.