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Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases |
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| Authors: | Kaouk Jihad H Autorino Riccardo Kim Fernando J Han Deok Hyun Lee Seung Wook Yinghao Sun Cadeddu Jeffrey A Derweesh Ithaar H Richstone Lee Cindolo Luca Branco Anibal Greco Francesco Allaf Mohamad Sotelo René Liatsikos Evangelos Stolzenburg Jens-Uwe Rane Abhay White Wesley M Han Woong Kyu Haber Georges-Pascal White Michael A Molina Wilson R Jeong Byong Chang Lee Joo Yong Linhui Wang Best Sara Stroup Sean P Rais-Bahrami Soroush Schips Luigi Fornara Paolo Pierorazio Phillip Giedelman Camilo Lee Jae Won Stein Robert J Rha Koon Ho |
| Institution: | a Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA b Denver Health Medical Center, University of Colorado Health Science Center, Denver, CO, USA c Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea d Department of Urology, Hanyang University College of Medicine, Seoul, South Korea e Department of Urology, Changhai Hospital, Shanghai, China f Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA g Division of Urology, University of California San Diego, La Jolla, CA, USA h Smith Institute for Urology, The Hofstra-North Shore-LIJ School of Medicine, New Hyde Park, NY, USA i Urology Unit, S. Pio da Pietralcina Hospital, Vasto, Italy j Department of Urology, Cruz Vermelha Hospital, Curitiba, Parana, Brazil k Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle/Saale, Germany l James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA m Unidad de Urología, Instituto Médico La Floresta, Venezuela n Department of Urology, University of Patras, School of Medicine, Patras, Greece o Department of Urology, University of Leipzig, Leipzig, Germany p Department of Urology, East Surrey Hospital, Redhill, Surrey, UK q Urology Cancer Center, University of Tennessee Medical Center, Knoxville, TN, USA r Department of Urology, Yonsei University College of Medicine, Seoul, South Korea |
| Abstract: | BackgroundLaparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years.ObjectiveTo report a large multi-institutional worldwide series of LESS in urology.Design, setting, and participantsConsecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis.InterventionEach group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques.MeasurementsDemographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications.Results and limitationsOverall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160 ± 93 min and estimated blood loss was 148 ± 234 ml. Skin incision length at closure was 3.5 ± 1.5 cm. Mean hospital stay was 3.6 ± 2.7 d with a visual analog pain score at discharge of 1.5 ± 1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases.ConclusionsThis study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied. |
| Keywords: | Laparoendoscopic single-site surgery Multi-institutional Single-port laparoscopy LESS Robotics Scarless surgery Urology |
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