Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question

Introduction: The development of endovision techniques and equipment miniaturization in urology make it possible to perform laparoendoscopic single-site (LESS) nephrectomy. Radical nephrectomy due to renal cancer performed with LESS is not a standard procedure in urology. Aim: To present our preliminary results and operative technique of LESS radical nephrectomy. Material and methods: The study was carried out after team experience based on LESS radical nephrectomy performed from October 2009 to June 2010 in 11 cases. A single port with 3 working channels (Tripod Access System, OLYMPUS (R)) and a 5 mm laparoscope 30 degrees were used. The approach was created by minilaparotomy technique on the lateral margin of the rectus muscle, 4 cm above the umbilicus. The procedure was performed using standard laparoscopic instruments, bent or articulating graspers, and scissors. During the surgery metal and plastic clips were used, and a mechanical vascular stapler in two cases. In every case bipolar coagulation was used. The postoperative specimen was removed via single-port minilaparotomy. After surgery, one suction drain 14 F was left. Results: In all patients the procedure was performed without conversion to standard, open technique. In two cases accessory port (10 and 12 mm) placement was necessary, for organ retraction or insertion of a vascular stapler Mean surgery time was 128 min (120-160 min). Mean blood loss was 155 ml (100-250 ml). There were no complications during surgery or the postoperative period. Mean hospitalization stay was 4 days (3-5 days). Clinical stage of renal cell cancer (RCC) was pT1a in 1, pT1b in 9, and pT3a in 1 patient. The results of histopathological examination show typical RCC in 10 cases, and papillary RCC in I. Conclusions: LESS nephrectomy is effective but technically difficult. LESS nephrectomy is a considerably less invasive procedure than standard laparoscopic nephrectomy, unless accessory port placement is necessary. LESS offers a very good cosmetic effect, which can be an attribute of the single-site approach. LESS radical nephrectomy makes it possible to perform efficient and safe kidney excision and seems to be a valuable alternative to classic surgery in properly selected cases.