Single-site urologic surgery: Is LESS really more?

The research by Autorino et al highlights the international acceptance of LESS, and more importantly, the clear evidence that LESS procedures are being done at an increasing rate since 2007. At this stage, the majority of the cases have been upper tract, extirpative/ablative procedures, which is logical as the instruments and technology may not be the same as that used in traditional laparoscopy or robotics. However, pyeloplasties and partial nephrectomies are also now being performed using LESS.

What is lacking with LESS is clear evidence of a benefit in convalescence compared to other minimally invasive approaches, and as a result, the major advantage of LESS is cosmetic. Regardless, the data from the Autorino study are compelling in that the complication rates, absolute pain scale results, and open conversions were quite acceptable and encouraging. The development of LESS has been positive as it has pushed laparoscopists to reconsider how many ports and the type of instruments they use, just as open prostate surgeons responded to robotic prostatectomy in the past decade.

Moreover, our commitment to our patients must be sustained. As a result, LESS is in everyone's future in one form or another. Just as more multicenter studies and randomized trials are expected (as are new benefits, I suspect), lower costs and a more refined understanding of LESS are on the horizon. The evolution of minimally invasive surgery continues.

Dr. Nakada, a Urology Times editorial consultant, is professor and chairman of urology, University of Wisconsin, Madison.