Laparoendoscopic single-site radical nephrectomy for renal cancer: technique and surgical outcomes
F. Greco*1, D. Veneziano*2,3, F. Kawan*2, N. Mohammed*2, C. Springer*2,4, P. Fornara2
1Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Urologie und Nierentransplantationszentrum, Halle Saale,Germany, 2Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Halle Saale, Germany, 3Ospedale di Reggio Calabria, Calabria, Italy, 4Rudolfstiftung, Wien, Austria
Background: Laparoendoscopic single-site (LESS) surgery has been developed in attempt to further reduce the morbidity andscarring associated with surgical intervention. To describe the technique and report the surgical outcomes of LESS radicalnephrectomy (LESS-RN) in the treatment of renal cell carcinoma.
Patients and methods: LESS-RN was performed in 33 patients with renal tumors. The indications to perform a LESS-RNwere represented by T2 renal tumors or lower without evidence of lymphadenopathy or renal vein involvement.The Endocone (Karl Storz, Tuttlingen, Germany) was inserted through a transumbilical incision. A combination of standardlaparoscopic instruments and bent grasper and scissors was used. The sequence of steps of LESS-RN was comparable tostandard laparoscopic radical nephrectomy.Demographic data and perioperative and postoperative variables were recorded and analysed.
Results: The mean operative time was 143.7±24.3 min, with a mean estimated blood loss of 122.3±34.1 ml and a meanhospital stay resulted to be 3.8±0.8. The mean length of skin incision was 4.1±0.6 cm and all patients were discharged fromhospital with minimal discomfort, as demonstrated by their pain assessment scores (VAS= 1.9 ±0.8). The definitive pathologicresults revealed a renal cell carcinoma in all cases with a stage distribution of four T1a, 27 T1b and 2 T2. All patients were verysatisfied with the appearance of the scars and at a median follow-up period of 13.2±3.9 months, all patients were alive withoutevidence of tumor recurrence or port-site metastasis.
Conclusions: LESS is a safe and feasible surgical procedure for radical nephrectomy (RN) in the treatment of renal cellcarcinoma, with excellent cosmetic results.