Suprapubic-assisted laparoendoscopic single-site surgery (LESS) in urology: our experience

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Laparoendoscopic single-site surgery (LESS) aims to reduce invasiveness and improve cosmesis.
• Traditional LESS can be technically challenging due to instrument triangulation limitations.
• Suprapubic-assisted LESS (SA-LESS) was developed to address these challenges.

Purpose of the Study:

• To evaluate the feasibility, safety, and efficacy of SA-LESS in a diverse range of urological procedures.
• To compare the outcomes of SA-LESS with umbilical LESS and standard laparoscopy.
• To assess the cosmetic results and postoperative pain associated with SA-LESS.

Main Methods:

• SA-LESS was performed on 236 patients.
• Trocars were placed at the umbilicus and below the pubic hairline.
• Conventional laparoscopic instruments were used with a flexible-tip laparoscope.

Main Results:

• SA-LESS was successfully completed in 229 patients (97%).
• Six patients required conversion to standard laparoscopy; one to open surgery.
• Procedures included adrenalectomy, nephrectomy, pyeloplasty, and ureterolithotomy with acceptable operative times and blood loss.
• Excellent cosmetic outcomes were achieved with hidden umbilical and suprapubic scars.

Conclusions:

• SA-LESS is a feasible, safe, and effective surgical technique in urology.
• The dual trocar placement enhances surgical ease and leads to reduced postoperative pain.
• SA-LESS offers superior cosmetic results compared to umbilical LESS.