LESS (laparoendoscopic single site surgery) nephrectomy – A technique for everyday clinical practise?
Milan Hora, Viktor Eret, Tomáš Ürge, Ivan Trávníček,Ondřej Hes, Fredrik Petersson, Petr Stránský
Charles University Hospital, Pilsen, Czech Republic, Department of 1Urology and 2Pathology
3Department of Pathology, National University Health System, Singapore
Correspondence: Prof. Milan Hora, MD, PhD
Department of Urology, University Hospital
E. Beneše 13
305 99 Plzeň
A pertinent question is the potential benefit(s) of LESS nephrectomy (NE) in comparison to standard laparoscopic NE (LNE). We herein report our institutional experience with LESS and give our opinion regarding this technique/procedure.
Since 8/2011 to 2/2013 we have performed 129 LNE. LESS technique was used in 22.3 % (n=29) of them. The decision on what procedure to perform did not follow any standardized approach.
LESS NE was performed on the right side in 17 patients and on the left side in 12 patients, respectively. The mean age was 59.9±15.0 years (25.9-87.4). The mean BMI was 27.2±4.1 (16-33). Seven patients (24%) were obese (BMI > 30). The mean operation time was 94.7±44.2 minutes (37-230), blood loss was 69.0±164.1 (0-800) ml, weight of specimen 392.8±164.4 (190-750) g. The patients were discharged from the hospital on 4.9±1.2 (3-8) postoperative day. Used devices were Quadport+®, one special pre-bent grasper and any sealing system (harmonic scalpel of different brands 7x, Ligasure® blunt tip 35 mm 15,7x harmonic scalpel and 7x Thunderbeat®). The hilar vessels were divided by stapler en bloc in 22 patients (76%) and with lockable clips in 7 patients (24%). In 9 patients (31%), one 3 mm auxiliary instrument was introduced directly through the abdominal wall to elevate the liver and/or spleen. In three of these cases (10%), a 12 mm port had to be added in order to introduce a stapler (i.e. conversion to standard laparoscopy). In no case was there conversion to open surgery. There was only one complication Clavien II (light cerebral stroke). The time of surgery was 73.8±18.9 (37-100) minutes for the more experienced surgeons (history of hundreds laparoscopic renal surgeries) and 128.4±49.0 (85-230) minutes for the three less experienced surgeons. In neoplasm aetiology (n=20), size of tumour was 51.0±16.7 (20-80 mm, histology were 17 clear RCCs and 3 oncocytomas.
LESS NE is indicated at our institution in only easier cases (i.e. mainly BMI mostly less than 30 and smaller/less advanced kidney tumours). It is safe and relatively fast method. LESS NE performed by a less experienced surgeon extends the time of surgery.
Supported by the project Ministry of Health, Czech Republic for conceptual development of research organization 00669806 – Faculty Hospital in Pilsen, Czech Republic