Laparoendoscopic single-site surgery of the kidney: an initial experience

Laparoendoscopic single-site surgery (LESS) has emerged as a natural progression from standard laparoscopy toward minimization of surgical morbidity. We present our initial experience with LESS renal surgery in order to assess safety, feasibility, and early postoperative outcomes.

Patients undergoing LESS renal surgery by a single surgeon from November 2008 to June 2010 were retrospectively identified. Safety, feasibility, and early outcomes were analyzed. Pain parameters were assessed using morphine equivalents used and visual analog pain scores (VAPS).

LESS procedures included 13 radical nephrectomy (1 bilateral), 5 simple nephrectomy (1 bilateral), 2 partial nephrectomy, 2 renal biopsy, and 1 renal cryoablation. Of 17 renal tumors, 15 were renal cell carcinoma and 2 had known renal vein involvement. Mean patient age was 55.4 years and mean BMI was 25.5 kg/m2. Mean operative time was 131 minutes (38-230), median estimated blood loss was 50 mL, and median length of stay was 2 days. There was one intraoperative transfusion and one conversion to conventional laparoscopy. The postoperative complication rate was 12% with two Clavien grade > 2 complications. Mean morphine equivalent dose of intravenous narcotics was 21.7 mg, and mean VAPS scores were 4.3, 3.5, and 2.9/10 on POD#0, #1, and day of discharge, respectively.

LESS surgery is safe and feasible for a wide variety of renal surgeries. Despite the selection bias of this early experience, postoperative outcomes and pain scores appear comparable to those reported for standard laparoscopy. Prospective studies comparing LESS to standard laparoscopic renal surgery are needed for definitive assessment.