Laparoendoscopic single-site and transvaginal nephrectomy

Significant energy has been applied to development of minimally-invasive techniques in surgery to decrease morbidity, improve cosmesis, and hasten postoperative convalescence without compromising surgical outcomes. The evolution of laparoscopy has revolutionized simple, radical and donor nephrectomy in appropriately selected patients, exchanging large flank and abdominal incisions for small "keyhole" incisions. Surgeons continue to pursue innovative approaches to minimize the morbidity of procedures. Natural orifice translumenal endoscopic surgery (NOTES) eliminates entirely the need for abdominal incisions, while laparoendoscopic single-site (LESS) surgery permits placement of multiple instruments through a single incision. Together, they represent two novel approaches developed within the last decade that have been successfully applied to nephrectomy in both the laboratory and clinical settings. Here, the transvaginal and LESS approaches to nephrectomy are reviewed.