SEARCH

SEARCH BY CITATION

Keywords:

  • single-port;
  • laparoscopy;
  • renal cell carcinoma;
  • surgical technique;
  • GFR;
  • renal function;
  • oncological outcome

What's known on the subject? and What does the study add?

  • Laparoendoscopic single-site (LESS) surgery has been used by urologists for a broad range of operations including LESS partial nephrectomy (LESS-PN). To date, experiences of LESS-PN have been presented as small series or as a subset of larger heterogeneous operative experiences, which have shown the overall feasibility and safety of this novel technique.
  • We report our experience with LESS-PN with complete pathological resection and excellent short-term oncological and renal functional outcomes in the select patient population who underwent this minimally invasive approach.

Objective

  • To present our experience of transumbilical laparoendoscopic single-site (LESS) partial nephrectomy (PN) with pathological and short-term oncological and renal functional outcomes.

Patients and Methods

  • In all, 15 LESS-PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon.
  • All patients underwent transumbilical LESS using a 5-mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments.
  • The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN.
  • Demographic, perioperative, and postoperative variables were recorded and analysed.

Results

  • Of the 14 patients (eight men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2–4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins.
  • The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0–37) min; bull-dog clamps were used for hilar-control in nine cases with the remaining six cases done without hilar vascular clamping.
  • The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions.
  • The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg.
  • Follow-up surveillance imaging showed no recurrence at a mean (sd, range) follow-up of 18.3 (12.2; 6–36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow-up of 17.1 (11.9; 1–36) months.

Conclusion

  • LESS-PN is a feasible and effective operation, providing complete oncological resection along with excellent short-term oncological and renal functional outcomes.