Laparoendoscopic single-site surgery (LESS) for major urological procedures in the pediatric population: A systematic review

• In the hands of experienced surgeons LESS is a feasible approach for pediatric urologic procedures.
• LESS can be performed for all major urologic procedures in the pediatric population.
• There is not enough evidence supporting LESS widespread adoption in the field.
• Prospective trials comparing LESS to conventional laparoscopy are warranted.

BackgroundImprovements in laparoscopic surgery have led to the introduction of laparoendoscopic single-site surgery (LESS) as an alternative to conventional laparoscopy conferring a number of possible advantages. In this review, we aim to elucidate the aspects of LESS for major urological procedures in the pediatric population.Materials and methodsAn in-depth search of the literature was performed in the databases of PubMed and Scopus, for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephrectomies, nephroureterectomies, varicocelectomies and pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively.ResultsTwenty nine studies met the inclusion criteria incorporating 386 patients who underwent 401 procedures. There were no major intraoperative complications, with only 19 patients (4.73%) facing postoperative complications. No perioperative deaths were reported.ConclusionsIn the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques.