Abstract
Laparoendoscopic single-site surgery (LESS) probably represents the next evolutionary step in laparoscopic surgery. Although most urologic procedures are feasible by the LESS approach, significant challenges in terms of intraoperative ergonomics and requirement for laparoscopic skill are present. New, specially designed instruments and ports represent a solution for combating ergonomic problems during surgery. Documentation of the advantages of LESS over other approaches is currently lacking, as comparative clinical trials are scarce in the literature; in the absence of such information, the technique has been accepted at centers of laparoscopic expertise. Thus, further prospective randomized clinical trials are necessary to fully characterize the outcomes of LESS.
Key Points
-
Laparoendoscopic single-site surgery (LESS) is a promising technique, but presents technical challenges that require further innovation of instruments and intensive training
-
Experience with urological LESS procedures comprises mostly feasibility studies and is constantly increasing
-
Many urologic procedures can be safely performed by the LESS approach
-
The technique is still challenging and requires high levels of laparoscopic expertise
-
LESS is difficult to perform using conventional laparoscopic instruments; new, specially designed instruments (flexible or pre-bent) will be invaluable for the success of LESS
-
Further studies are needed to evaluate the long-term outcomes of LESS; moreover, comparative studies of LESS and conventional laparoscopic approaches are needed to determine whether LESS offers advantages over conventional laparoscopy
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Clayman, R. V. et al. Laparoscopic nephrectomy: initial case report. J. Urol. 146, 278–282 (1991).
Dunn, M. D. et al. Laparoscopic versus open radical nephrectomy: a 9-year experience. J. Urol. 164, 1153–1159 (2000).
Rassweiler, J., Frede, T., Henkel, T. O., Stock, C. & Alken, P. Nephrectomy: a comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach. Eur. Urol. 33, 489–496 (1998).
Abbou, C. C. et al. Retroperitoneal laparoscopic versus open radical nephrectomy. J. Urol. 161, 1776–1780 (1999).
Taylor, G. D. & Cadeddu, J. A. applications of laparoscopic surgery in urology: impact on patient care. Med. Clin. North Am. 88, 519–538 (2004).
Gill, I. S., Clayman, R. V. & McDougall, E. M. Advances in urological laparoscopy. J. Urol. 154, 1275–1294 (1995).
Stolzenburg, J.-U. et al. Current status of laparoendoscopic single-site surgery in urology. World J. Urol. doi:10.1007/s00345-009-0459-0.
Gill, I. S. Consortium establishes criteria for single-port surgery. Renal and Urology News [online], (2008).
Tracy, C. R., Raman, J. D., Cadeddu, J. A. & Rane, A. Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat. Clin. Pract. Urol. 5, 561–568 (2008).
Box, G. et al. Nomenclature of natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) procedures in urology. J. Endourol. 22, 2575–2581 (2008).
Wheeless, C. R. Jr. A rapid, inexpensive, and effective method of surgical sterilization by laparoscopy. J. Reprod. Med. 3, 65–69 (1969).
Wheeless, C. R. Jr & Thompson, B. H. Laparoscopic sterilization: review of 3,600 cases. Obstet. Gynecol. 42, 751–758 (1973).
Pelosi, M. A. & Pelosi, M. A. III. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N. J. Med. 88, 721–726 (1991).
Pelosi, M. A. & Pelosi, M. A. III. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J. Reprod. Med. 37, 774–784 (1992).
Navarra, G., Pozza, E., Occhionorelli, S., Carcoforo, P. & Donini, I. One-wound laparoscopic cholecystectomy. Br. J. Surg. 84, 695 (1997).
Milliken, I., Fitzpatrick, M. & Subramanian, R. Single-port laparoscopic insertion of peritoneal dialysis catheter in children. J. Pediatr. Urol. 2, 308–311 (2006).
Hirano, D. et al. Retroperitoneoscopic adrenalectomy for adrenal tumors via a single large port. J. Endourol. 19, 788–792 (2005).
Cobellis, G., Cruccetti, A., Mastroianni, L., Amici, G. & Martino, A. One-trocar transumbilical laparoscopic-assisted management of Meckel's diverticulum in children. J. Laparoendosc. Adv. Surg. Tech. A 17, 238–241 (2007).
Gettman, M. T., Lotan, Y., Napper, C. A. & Cadeddu, J. A. Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 59, 446–450 (2002).
Clayman, R. V. et al. Rapid communication: transvaginal single-port NOTES nephrectomy: initial laboratory experience. J. Endourol. 21, 640–644 (2007).
Box, G. N. et al. Rapid communication: robot-assisted NOTES nephrectomy: initial report. J. Endourol. 22, 503–506 (2008).
Rane, A., Rao, P., Bonadio, F. & Rao P. Single port laparoscopic nephrectomy using a novel laparoscopic port (R-port) and evolution of single laparoscopic port procedure (SLIPP) [abstract]. J. Endourol. 21 (Suppl. 1), A287 (2007).
Rane, A., Rao, P. & Rao P. Single port access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-Port). Urology 72, 260–264 (2008).
Stein, R. J. et al. Robotic laparoendoscopic single-site surgery using Gelport as the access platform. Eur. Urol. doi:10.1016/j.eururo.2009.03.054
Raman, J. D., Cadeddu, J. A., Rao, P. & Rane, A. Single incision laparoscopic surgery: initial urological experience and comparison with natural-orifice transluminal endoscopic surgery. BJU Int. 101, 1493–1496 (2008).
Park, S. et al. Trocar-less instrumentation for laparoscopy: magnetic positioning of intra-abdominal camera and retractor. Ann. Surg. 245, 379–384 (2007).
Zeltser, I. S. et al. Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model. J. Urol. 178, 288–291 (2007).
Caddedu, J. et al. Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience. Surg. Endosc. 23, 1894–1899 (2009).
Desai, M. M. et al. Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU Int. 101, 83–88 (2008).
Kommu, S. S. & Rané, A. Devices for laparoendoscopic single-site surgery in urology. Expert Rev. Med. Devices 6, 95–103 (2009).
Desai, M. M. et al. Laparoendoscopic single-site surgery: initial hundred patents. Urology 74, 805–812 (2009).
White, W. M. et al. Single-port urological surgery: single-center experience with the first 100 cases. Urology 74, 801–804 (2009).
Kaouk, J. H. et al. Single port laparoscopic ablative and reconstructive surgery in urology [abstract]. J. Urol. 179 (4 Suppl.), 239 (2008).
Rao, P., Desai, M. M., Gill, I. S., Rane, A. & Rao, P. P. E-NOTES: a new paradigm: experience in 33 cases [abstract]. J. Urol. 179 (4 Suppl.), 238 (2008).
Kaouk, J. H. et al. Single-port laparoscopic surgery in urology [abstract]. J. Urol. 179 (4 Suppl.), 306 (2008).
Raman, J. D., Bensalah, K., Bagrodia, A., Stern, J. M. & Cadeddu, J. A. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 70, 1039–1042 (2007).
Kaouk, J. H. et al. Single-port laparoscopic surgery in urology: initial experience. Urology 71, 3–6 (2008).
Ponsky, L. E., Cherullo, E. E., Sawyer, M. & Hartke, D. Single access site laparoscopic radical nephrectomy: initial clinical experience. J. Endourol. 22, 663–666 (2008).
Stolzenburg, J. U. et al. Laparoendoscopic single-site surgery: early experience with tumor nephrectomy. J. Endourol. 23, 1287–1292 (2009).
Stolzenburg, J. U. et al. Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur. Urol. 56, 644–650 (2009).
Goel, R. K. & Kaouk, J. H. Single port access renal cryoablation (SPARC): a new approach. Eur. Urol. 53, 1204–1209 (2008).
Aron, M. et al. Transumbilical single-port laparoscopic partial nephrectomy. BJU Int. 103, 516–521 (2009).
Kaouk, J. H. & Goel, R. K. Single port laparoscopic and robotic partial nephrectomy. Eur. Urol. 55, 1163–1169 (2009).
Desai, M. M. et al. Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience. Urology 73, 182–187 (2009).
Haber, G. P. et al. Robotic NOTES (Natural Orifice Translumenal Endoscopic Surgery) in reconstructive urology: initial laboratory experience. Urology 71, 996–1000 (2008).
Kaouk, J. H. et al. Single-port laparoscopic radical prostatectomy. Urology 72, 1190–1193 (2008).
Barret, E. et al. A transition to laparoendoscopic single-site surgery (LESS) radical prostatectomy: human cadaver experimental and initial clinical experience. J. Endourol. 23, 135–140 (2009).
Kaouk, J. H. & Palmer, J. S. Single-port laparoscopic surgery: initial experience in children for varicocelectomy. BJU Int. 102, 97–99 (2008).
Park, Y. H., Kang, M. Y., Jeong, M. S., Choi, H. & Kim, H. H. Laparoendoscopic single-site nephrectomy using a homemade single-port device for single-system ectopic ureter in a child: initial case report. J. Endourol. 23, 833–835 (2009).
Raman, J. D., Bagrodia, A. & Cadeddu, J. A. Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. BJU Int. 103, 1198–1204 (2009).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Liatsikos, E., Kallidonis, P., Kyriazis, I. et al. Urologic laparoendoscopic single-site surgery. Nat Rev Urol 6, 654–659 (2009). https://doi.org/10.1038/nrurol.2009.217
Issue Date:
DOI: https://doi.org/10.1038/nrurol.2009.217
This article is cited by
-
Factors affecting operative efficiency and post-operative convalescence in laparoendoscopic single-site (LESS) adrenalectomy
Surgical Endoscopy (2018)
-
Is there any role for minimally invasive surgery in NET?
Reviews in Endocrine and Metabolic Disorders (2017)
-
Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique
Surgical Endoscopy (2017)
-
Performance analysis on physical simulator of four different instrument setups in laparo-endoscopic single-site (LESS) surgery
Surgical Endoscopy (2014)
-
Laparoendoscopic Single-Site Surgery in Kidney Surgery: Clinical Experience and Future Perspectives
Current Urology Reports (2013)