Transumbilical laparoendoscopic single-site surgery(LESS) partial nephrectomy: a median follow-up of 2 years

ObjectiveNephron-sparing surgery (NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery. Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis; LESS is developing quickly and its indications have been expanded, but still in its infancy. The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy (LESS-PN), so as to assess its utility, safety and efficacy.MethodsFrom August 2009 to October 2010, 3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution. Patient demographics, perioperative and follow-up data were prospectively collected and analyzed.ResultsAll the three procedures were successfully completed. A 5-mm ancillary trocar was utilized in all 3 cases. The mean operative duration was 226.3 (210–254 min) with an estimated blood loss of 56.7 ml (20–100 ml). Mean warm ischemia time was 35.7 min (19–48 min). One patient was transfused due to postoperative bleeding. The recovery was uneventful and mean length of postoperative stay was 13 days (12–14 days). At the latest follow-up, all patients remained symptom-free and had normal renal function without evidence of recurrence, and they were delighted for a hidden transumbilical scar.ConclusionTransumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging. Surgical outcomes at a median follow-up of 2 years are promising, while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.