Renal cancer. Contemporary management. Editor John A. Libertino. Springer New York, 2013
Laparoendoscopic single-site partial nephrectomy
Laparoendoscopic single-site surgery (LESS) is gaining momentum in the urologic community pushing the limits of minimally invasive surgical techniques. A recent literature review suggests that transumbilical LESS is feasible for experienced laparoscopists. Autorino et al. reported their experience with LESS, which included 133 partial nephrectomies. The majority (61%) of cases were converted to reduced port (52.6%), traditional laparoscopy (6.8%), or open (1.5%). More revealing is that LESS partial nephrectomy was performed successfully in 52 patients, the largest of any series. Six patients had intraoperative complications with an overall complication rate of 9.8%. Four patients had major complications defined as either requiring an additional procedure or experiencing single organ dysfunction. A comparison of laparoscopic to LESS partial nephrectomy has yet to be performed, but this data will be essential in establishing functional and oncologic outcomes. Standard laparoscopic LESS is also being extended into the robotic arena where specialized instrumentation is being conceived to improve dexterity. It remains to be seen if LESS provides any benefit over multitrocar minimally invasive procedures.