Video of laparoscopic endoscopic single site surgery (LESS) - tumor nephrectomy



J.-U. Stolzenburg1, M. Do1, T. Häfner*1, A. Dietel1, J. Beatty*1

1Universität Leipzig AöR, Klinik und Poliklinik für Urologie, Leipzig, Germany

Introduction: The concept of scar-free surgery has been a long-standing dream that is close to being realised by laparoscopic endoscopic single site surgery (LESS). This video demonstrates our technique of LESS - tumour nephrectomy step by step.

Materials and Methods: 36 patients underwent single port nephrectomy using the Quad-Port (Olympus), inserted via an umbilical or paraumbilical incision. Novel, prebended grasper and scissor (Olympus) and a 5mm camera (Olympus) with bendable handle were used in addition to standard laparoscopic equipment.

Results: All operations were technically successful, with no conversion to open surgery. All were for renal cell carcinoma (17 right-sided and 19 left-sided) with a median diameter of 5.9 cm (range 4 - 9 cm). In three cases we had to convert to standard laparoscopic technique. One patient required transfusion, one patient has had prolonged ileus. The median operative duration was 148minutes (range 90 - 190). No positive surgical margin has been detected.

Conclusions: We found that LESS is a feasible and safe approach that has been made possible by the development of the multiport and prebended laparoscopic instruments. The patients were subjectively pleased with their operations and no oncological compromise occurred. Single site surgery presents the closest approximation to scar-free surgery and will probably play an important role in the future development of laparoscopic surgery.

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