Laparoendoscopic single‐site (LESS) partial nephrectomy short‐term outcomes

• Published in: BJU international Vol. 111; no. 2; pp. 264 - 270
• Main Authors: Rais‐Bahrami, Soroush, George, Arvin K., Montag, Sylvia, Okhunov, Zhamshid, Richstone, Lee
• Format: Journal Article
• Language: English
• Published: Oxford Wiley-Blackwell 01.02.2013; Wiley Subscription Services, Inc
• Subjects: Aged; Biological and medical sciences; Blood Loss, Surgical - statistics & numerical data; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - physiopathology; Carcinoma, Renal Cell - surgery; Conversion to Open Surgery - statistics & numerical data; Feasibility Studies; Female; GFR; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - physiopathology; Kidney Neoplasms - surgery; Kidneys; laparoscopy; Laparoscopy - methods; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Nephrectomy - methods; Nephrology. Urinary tract diseases; oncological outcome; Operative Time; Pain, Postoperative - etiology; renal cell carcinoma; renal function; single‐port; surgical technique; Treatment Outcome; Tumor Burden; Tumors of the urinary system; Warm Ischemia; Short term; Site; Nephrology; Carcinoma; Renal function; Prognosis; Urology; surgical technique; GFR; Nephrectomy; Partial; Surgery; Grawitz tumor; Endoscopy; Kidney disease; Urinary system disease; single-port; Laparoscopy; Malignant tumor; Glomerular filtration rate; renal cell carcinoma; Treatment; oncological outcome; Kidney cancer; Technique; Cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2012.11374.x

What's known on the subject? and What does the study add? Laparoendoscopic single‐site (LESS) surgery has been used by urologists for a broad range of operations including LESS partial nephrectomy (LESS‐PN). To date, experiences of LESS‐PN have been presented as small series or as a subset of larger heterogeneous operative experiences, which have shown the overall feasibility and safety of this novel technique. We report our experience with LESS‐PN with complete pathological resection and excellent short‐term oncological and renal functional outcomes in the select patient population who underwent this minimally invasive approach. Objective To present our experience of transumbilical laparoendoscopic single‐site (LESS) partial nephrectomy (PN) with pathological and short‐term oncological and renal functional outcomes. Patients and Methods In all, 15 LESS‐PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon. All patients underwent transumbilical LESS using a 5‐mm flexible‐tip laparoscope and a combination of flexible and conventional laparoscopic instruments. The technique for transperitoneal LESS‐PN otherwise replicated conventional laparoscopic PN. Demographic, perioperative, and postoperative variables were recorded and analysed. Results Of the 14 patients (eight men), undergoing 15 distinct LESS‐PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2–4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins. The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0–37) min; bull‐dog clamps were used for hilar‐control in nine cases with the remaining six cases done without hilar vascular clamping. The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions. The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg. Follow‐up surveillance imaging showed no recurrence at a mean (sd, range) follow‐up of 18.3 (12.2; 6–36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow‐up of 17.1 (11.9; 1–36) months. Conclusion LESS‐PN is a feasible and effective operation, providing complete oncological resection along with excellent short‐term oncological and renal functional outcomes.