Retrospective Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Nov 24, 2014; 3(3): 358-363
Published online Nov 24, 2014. doi: 10.5410/wjcu.v3.i3.358
Single-site laparoscopic partial nephrectomy: Where are we going?
Roberto Castellucci, Luca Cindolo, Mario Alvaréz-Maestro, Guido Giusti, Francesco Berardinelli, Fabio Pellegrini, Luigi Schips
Roberto Castellucci, Mario Alavaréz-Maestro, Urology Department, Hospital “Infanta Sofia”, 65129 Madrid, Spain
Luca Cindolo, Francesco Berardinelli, Fabio Pellegrini, Luigi Schips, Urology Department, Hospital “S.Pio da Pieterelcina”, 66054 Vasto, Italy
Guido Giusti, Stone Center, Urology Department, Humanitas Clinical and Research Center, 20089 Rozzano, Italy
Author contributions: Castellucci R and Cindolo L performed the majority of research and wrote majority of the manuscript; Alvaréz-Maestro M, Giusti G, Berardinelli F and Pellegrini F wrote part of manuscript; Schips L designed the study.
Correspondence to: Dr. Roberto Castellucci, Urology Department, Hospital “Infanta Sofia”, Via Ofanto 16, 65129 Madrid, Spain. roberto.castellucci@gmail.com
Telephone: +39-32-95449222
Received: April 18, 2014
Revised: June 23, 2014
Accepted: July 29, 2014
Published online: November 24, 2014
Processing time: 214 Days and 18.7 Hours
Abstract

AIM: To review an evolution of laparoscopic surgery, there has been a growing interest in laparoendoscopic single-site surgery (LESS).

METHODS: A comprehensive electronic literature search was conducted using PubMed database to identify all publications relating to LESS-partial nephrectomy (PN). The research includes articles published from April 2008 to January 2014. We focused our attention only on articles in which were cited the single-site surgical technique (laparoscopic and robotic), tumour stage and grade, mean tumour size, intraoperative variables, blood loss and transfusion rate, length of post-operative stay and complication rates, Clavien classification, positive of surgical margins, pain assessment at discharge.

RESULTS: A total of 9 studies were collected with 221 patients included. The mean patients age was 62 years. The mean tumor size was 2.35 cm with a mean operative time of 181 min (range 111-270 min) and 58.3% were done by robot. The mean ischemia time was 23.6 min. The 25.8% of patients underwent an unclamp LESS-PN. Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d. The rate of severe post-operative complications (≥ Clavien grade III) was 5.4%. Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery. Regarding oncologic outcomes, surgical margins were positive 4% of patients (9/221), no distant or port-site metastases were recorded.

CONCLUSION: LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain, shorter median hospital stay, shorter recovery time, and better cosmetic satisfaction without compromising surgical and oncological safety.

Keywords: Nephron sparing surgery, Partial nephrectomy, Laparoendoscopic single-site surgery, Single-port access surgery, Single-incision laparoscopic surgery, Robotic single-port partial nephrectomy

Core tip: In recent years, there has been a growing interest in laparoendoscopic single-site surgery (LESS). Some authors has used da Vinci surgical system for LESS surgery. Although almost every laparoscopic procedure in urology has been duplicated by using a LESS approach, only a few studies have reported problems and challenges encountered during LESS partial nephrectomy. The aim of our study is to evaluate the current literature in order to assess the efficiency, safety, and potential advantages of LESS-partial nephrectomy and Robotic-LESS PN.