Use of laparoendoscopic single-site surgery (LESS) rising across range of urologic procedures

Washington-Laparoendoscopic single-site surgery (LESS) has evolved to the point that a broad range of urologic procedures can be performed effectively and safely by applying different techniques, according to a review of the worldwide experience of more than 900 cases.

Retrospective data of patients undergoing LESS were collected from 14 institutions in the United States, Europe, Asia, and South America between August 2007 and November 2010, and these data were presented by first author Riccardo Autorino, MD, at the AUA annual meeting in Washington.

The procedures were categorized as follows:

Operative data related to the surgical procedure were access technique (single port or single incision), access site (umbilical or extra-umbilical), approach (transperitoneal or retroperitoneal), use of articulating/prebent laparoscopic instruments), use of the da Vinci robotic surgical system (Intuitive Surgical, Inc., Sunnyvale, CA), type of single-port device, and the use of ancillary 2-mm or 3-mm needlescopic/minilaparoscopic ports.

Overall, 916 patients underwent LESS during the study period. Their mean age was 52.1 years, mean BMI was 25.3 kg/m² , and their mean ASA physical status score was 1.7. About one-fourth (24.3%) had previous abdominal/pelvic surgery. The most frequent indication for LESS was renal tumor or mass (339 patients).

Ninety-one percent underwent upper urinary tract surgery, extirpative/ablative surgery was performed in 84%, 16% of cases were done using the da Vinci robot, and a transperitoneal approach was used in 95% of cases. Articulating or prebent instruments were used in 75% of the cases.

In 73% of surgeries, a single port was used, and in 27%, a single incision was used. Commercially available single-port devices were used in almost 50% of cases, whereas 43% of cases were done using a homemade device.