Contemporary perspectives on laparoendoscopic single-site surgery in urologic training and practice

The initial surge of interest in laparoendoscopic single-site (LESS) surgery is balanced by skepticism regarding its future. We sought to evaluate the perspectives of practicing urologists on the role of LESS in urologic training and practice.

An anonymous questionnaire was electronically mailed to members of the Endourological Society and the American Urological Association. Questions were grouped in three domains: training background and LESS experience, perspectives on LESS training, and perspectives on LESS in a current urologic practice.

Four hundred twenty-two surveys were completed. Respondents had a mean of 11.7 years in practice and 60.7% completed fellowship training. LESS was performed by 44.7% of respondents, however, of these respondents, 75% had only performed <10 LESS cases. For timing of LESS training, 50% believed LESS should be taught during residency and 39% during fellowship. Hands-on workshops and courses were thought to be insufficient by a majority (56%) for learning the LESS techniques before use in practice, and 51% support a credentialing process for urologists performing LESS surgery. Assessing the role of LESS in urologic practice, in its current state, LESS was deemed to provide superior cosmesis (69%) more commonly believed by those with LESS experience 77% versus 63% (p=0.004), however, without yielding a quicker recovery (75%) or less postoperative pain (73%).

LESS is viewed as an area with potential growth with benefits of superior cosmesis. LESS training should be more integrated into residency and fellowship training and establishing a credentialing process for LESS should be strongly considered by accrediting bodies.