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  • Review Article
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Urologic laparoendoscopic single-site surgery

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

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Figure 1: Access devices.
Figure 2: Articulating forceps.

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Correspondence to Evangelos Liatsikos.

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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

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