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AbstractThe indications, instrumentation, surgical technique, and complications of laparoendoscopic single-site radical nephrectomy (LESS-RN) are being described in detail in an attempt to familiarize urologists with this novel laparoscopic technique. Our initial experience of 30 consecutive cases of LESS-RN is reported. The results indicate that, in experienced hands, LESS-RN is feasible and safe, with results comparable to those of conventional laparoscopic radical nephrectomy. Nevertheless, larger series of patients are needed to prove if the increased technical difficulty of LESS-RN justifies its use in routine urologic practice. [ABSTRACT FROM AUTHOR]

AbstractObjectives:We report the outcome of 2400 endoscopic extraperitoneal radical prostatectomy (EERPE) cases performed in three institutions, with emphasis on the evolution of the EERPE technique.Methods:In total, 2400 EERPE procedures were performed in three institutions. Several surgeons performed the operations. The presented cases also include the learning curve of the surgeons. EERPE was performed in all cases of localized prostate cancer with the same indications to open and transperitoneal laparoscopic radical prostatectomy.Results:Average patient age was 63.3 years (range 41–81 years), and mean preoperative prostate specific antigen (PSA) level was 9.8 ng/mL (range 0.08–93 ng/mL); 857 (38%) patients had previously undergone abdominal or pelvic surgery, while 143 (5.8%) patients had prior prostatic treatment. Pelvic lymph node dissection took place in 1219 (50.8%) patients. Bilateral nerve sparing was performed in 672 patients and unilateral in 284 patients; 100 patients underwent intraoperative hernia repair with mesh placement (82 unilateral and 18 bilateral). Mean operative time was 150.7 minutes (range 50–340 minutes). Conversion to open surgery was never deemed necessary. Fifteen patients received transfusion (0.7%). The mean catheterization time was 6.19 days (range 3–40 days). Overall, 71.7% and 94.7% of the patients were continent at 3 and 12 months, respectively. Totally, 956 patients were treated with nerve-sparing procedure either interfascial or intrafascial; 672 patients underwent bilateral neurovascular bundle preservation, and 284, unilateral. Younger patients tend to have better postoperative potency. Bilateral nerve-sparing EERPE in patients younger than 55 years results in potency rate of 32.4%, 75.3%, and 84.9% at 3, 6, and 12 months postoperatively.Conclusions:The functional and oncological outcome of EERPE is comparable to other approaches for radical prostatectomy. Continuous refinements contribute to the improving outcome of the procedure. Long-term results especially in terms of oncological efficacy are expected. [ABSTRACT FROM AUTHOR]

AbstractBackground and Purpose:Laparoendoscopic single-site surgery (LESS) represents the closest surgical technique to scar-free surgery. We performed LESS for renal tumor nephrectomy in eight patients to assess feasibility and perioperative outcome.Patients and Methods:Eight patients with a body mass index (BMI) ≤30 underwent single-port nephrectomy for renal tumor by an experienced laparoscopic surgeon. Tri-Ports were used through a transumbilical incision in all cases. A flexible grasper and a 5-mm 30-degree high-definition camera were used in addition to standard laparoscopic equipment. Patient demographics; operative details, including procedure duration, blood loss, and complications; and final pathology results were prospectively recorded. Postoperative evaluation of pain and use of analgesic medication were recorded.Results:All LESS nephrectomy operations were successfully accomplished without the need to convert to conventional laparoscopy. The median patient age was 60.75 years (range 22–76 years) and median BMI was 22.95 (range 18.2–26.1). The median operative duration was 141 minutes (range 120–180 min), and the median blood loss was 103 mL (range 50–150 mL). Histologic evaluation confirmed complete excision of an intact specimen. All cases revealed organ-confined T1renal-cell carcinoma (two right-sided and six left-sided, tumor diameter range 4–8 cm). A tumor with an adjacent simple renal cyst was excised in one patient. No intraoperative or postoperative complications occurred.Conclusions:LESS was a feasible and safe approach in a selected group of patients (low BMI and stage tumor). LESS nephrectomy was made possible with the use of multi-instrument port and flexible instruments. The oncologic outcome was not compromised. Further evaluation of LESS surgery needs prospective, randomized studies. [ABSTRACT FROM AUTHOR]