Single‐incision laparoscopic colonic surgery

Aim SILS is an area of growing interest in colorectal surgery. We report our preliminary experience of 13 consecutively selected patients undergoing colonic surgery using SILS. Method From July 2009 to January 2010, 13 patients (five men) of median age 56 (23–82) years and a body mass index (BMI) of 23.5 (18–30) kg/m² underwent colonic surgery. Procedures included subtotal colectomy (1), ileocolic resection (2), right colectomy (4) and sigmoidectomy for benign disease (6). Three instruments (including camera) were introduced through a single 2.5‐cm port (SILS? Port Multiple Instrument Access Port; Covidien Inc., Norwalk, Connecticut, USA) inserted at the umbilicus. Results The median operating time was 150 (100–240) min, and the median size of the umbilical port incision was 32 (25–50) mm. There was no postoperative mortality and morbidity, and the median hospital stay was 6 (4–10) days. The cosmetic result was judged to be excellent in 12 of 13 patients who felt it to be better than expected. Conclusion This preliminary experience shows that SILS is technically feasible and safe for colonic resection.     

Initial operative experience of single‐port retroperitoneal laparoscopic nephrectomy

This paper reports our early experience with single‐port laparoscopic nephrectomy via the retroperitoneal approach. Since April 2010, 23 patients have undergone single‐port laparoscopic surgery for simple nephrectomy (n = 11 patients) and radical nephrectomy (n = 12) by an experienced laparoscopic surgeon. The mean operative time was 265.2 min and the mean estimated blood loss was 96.7 mL. The procedure was completed in all patients without conversion to standard laparoscopy or open surgery. No intraoperative or acute postoperative complications occurred. When the single‐port retroperitoneal laparoscopic nephrectomy group was retrospectively compared with the group that had undergone standard retroperitoneal laparoscopic nephrectomy, no significant difference was noted with respect to age, body mass index, operation time, time to eat, catheter removal or length of hospitalization (P > 0.05). A significant difference in favor of the single‐port retroperitoneal laparoscopic nephrectomy group was noted with respect to the estimated blood loss (P = 0.027) and the visual analog pain scale score at discharge (P = 0.016). Although our findings show that retroperitoneal single‐port laparoscopic nephrectomy is feasible with advanced techniques and optimal instrumentation, further study is required to determine the future extent of its clinical application.     

Single‐port ‘scarless’ laparoscopic nephrectomies: the United Kingdom experience

OBJECTIVE

To present the UK experience to date with laparoendoscopic single‐site surgery (LESS) simple nephrectomy.

PATIENTS AND METHODS

Five female patients underwent LESS nephrectomy; three procedures were carried out with the umbilicus as the port of entry (U‐LESS).

RESULTS

All cases were completed uneventfully. The operative duration was 45–150 min and blood loss was negligible. There were no conversions to conventional multi‐port laparoscopy or open surgery. Recovery was uneventful with only minor complications in two patients; convalescence was rapid.

CONCLUSION

LESS nephrectomy offers a safe, cosmetic alternative to conventional multi‐port laparoscopy, with younger female patients being especially happier with the ‘scarless’ outcome of U‐LESS. LESS certainly appears to be more in these situations.     

Laparoendoscopic single‐site (LESS) vs laparoscopic living‐donor nephrectomy: a systematic review and meta‐analysis

The aim of this study was to provide a systematic review and meta‐analysis of reports comparing laparoendoscopic single‐site (LESS) living‐donor nephrectomy (LDN) vs standard laparoscopic LDN (LLDN). A systematic review of the literature was performed in September 2013 using PubMed, Scopus, Ovid and The Cochrane library databases. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta‐analyses criteria. Weighted mean differences (WMDs) were used to measure continuous variables and odds ratios (ORs) to measure categorical ones. Nine publications meeting eligibility criteria were identified, including 461 LESS LDN and 1006 LLDN cases. There were more left‐side cases in the LESS LDN group (96.5% vs 88.6%, P < 0.001). Meta‐analysis of extractable data showed that LLDN had a shorter operative time (WMD 15.06 min, 95% confidence interval [CI] 4.9–25.1; P = 0.003), without a significant difference in warm ischaemia time (WMD 0.41 min, 95% CI –0.02 to 0.84; P = 0.06). Estimated blood loss was lower for LESS LDN (WMD ?22.09 mL, 95% CI –29.5 to –14.6; P < 0.001); however, this difference was not clinically significant. There was a greater likelihood of conversion for LESS LDN (OR 13.21, 95% CI 4.65–37.53; P < 0.001). Hospital stay was similar (WMD –0.11 days, 95% CI –0.33 to 0.12; P = 0.35), as well as the visual analogue pain score at discharge (WMD –0.31, 95% CI –0.96 to 0.35; P = 0.36), but the analgesic requirement was lower for LESS LDN (WMD –2.58 mg, 95% CI –5.01 to –0.15; P = 0.04). Moreover, there was no difference in the postoperative complication rate (OR 1.00, 95% CI 0.65–1.54; P = 0.99). Renal function of the recipient, as based on creatinine levels at 1 month, showed similar outcomes between groups (WMD 0.10 mg/dL, –0.09 to 0.29; P = 0.29). In conclusion, LESS LDN represents an emerging option for living kidney donation. This procedure offers comparable surgical and early functional outcomes to the conventional LLDN, with a lower analgesic requirement. However, it is more technically challenging than LLDN, as shown by a greater likelihood of conversion. The role of LESS LDN remains to be defined.     

Laparo‐endoscopic single‐site surgery: preliminary advances in renal surgery

We reviewed the preliminary advances in laparo‐endoscopic single‐site surgery (LESS) as applied to renal surgery, and analyzed current publications based on animal models and human patients. We searched published reports in major urological meeting abstracts, Embase and Medline (1966 to 25 August 2008), with no language restrictions. Keyword searches included: ‘scarless’, ‘scar free’, ‘single port/trocar/incision’, ‘intraumbilical’, and ‘transumbilical’, ‘natural orifice transluminal endoscopic surgery’ (NOTES), ‘SILS’, ‘OPUS’ and ‘LESS’. The lessons learnt from the studies using the porcine model are that further advances in instrumentation are essential to achieve optimum results, and that testing survival in animals is also necessary to further expand the NOTES and LESS techniques. Further advances in instrument technology together with increasing experience in NOTES and LESS approaches have driven the transition from porcine models to human patients. In the latter, studies show that the techniques are feasible provided that both optimal surgical technical expertise with advanced skills, and optimal instrumentation, are available. The next step towards minimal access/minimally invasive urological surgery is NOTES and LESS. It is inevitable that LESS will be extended to involve more complex and technically demanding procedures such as laparoscopic radical prostatectomy and partial nephrectomy.     

Laparoendoscopic single‐site urological surgery: Initial experience in Japan

The objective of this paper is to report our initial experience in laparoendoscopic single‐site surgery (LESS). One patient underwent LESS varicocelectomy and another patient underwent LESS pyeloplasty. The Triport was inserted into the abdomen through the umbilical incision. In the varicocelectomy, testicular vessels were coagulated by a vessel‐sealing system, and transected. In the pyeloplasty, a 2‐mm needlescopic port was added to facilitate the procedure, and a dismembered procedure was performed. Total operative duration was 60 min for the varicocelectomy and 240 min for the pyeloplasty. Blood loss was minimal and no perioperative complications occurred. At the 3‐month follow up, no postoperative complications were observed and there was no complaint of pain. LESS varicocelectomy and pyeloplasty were successfully performed with excellent cosmetic results and no complications.