Laparoendoscopic Single-Site Surgery: Initial Hundred Patients

UroToday.com - This is the first report of a large number of patients who underwent laparoendoscopic single site surgery (LESS). The work was done at three sites (Cleveland, Ohio; Caracas, Venezuela; and Gujarat, India).

Overall, 15% of all of the laparoscopic procedures at these institutions were performed using LESS between October 2007 and December 2008. These procedures included renal ablative (nephrectomy - simple, donor, and radical; partial nephrectomy; nephroureterectomy), renal reconstructive (pyeloplasty), and transvesical simple prostatectomy. Procedures were done using the r-Port in combination with bent/articulating as well as standard laparoscopic instruments. Additional ports were needed in 6% and there was a 4% conversion rate. Extensive data were collected including hospital stay, complications, analgesic use, return to work and complete convalescence. At this time, the data for LESS are quite similar to the data for standard laparoscopy. No analysis of cost was done in this report; however, the r-PORT and the disposable articulating instruments are additional expenses that need to be considered. Other surgeons using LESS have been able to decrease the cost by using standard periumbilical trocars (e.g. Dr. Cadeddu at UT Southwestern) and nondisposable bent instruments. The authors sagely and cautiously note in their conclusion: "The LESS urologic surgery is feasible for select indications, albeit technically challenging. Outcomes in the short term appear comparable to conventional laparoscopy as reported in published data. Prospective studies comparing outcomes of LESS surgery with standard laparoscopy will determine the future direction of this approach."

The age old saw of "it's new, but is it better?" needs to be applied, especially when "new" means more difficult for the surgeon to master and more expensive. As with the slow adaptation of laparoscopy versus open surgery, the urological community needs to know if LESS vs. standard laparoscopy will provide equal efficacy as well as equal or better efficiency at less cost and with improved patient well-being (i.e. less analgesic use, shorter hospital stay, quicker convalescence and better cosmesis).

At this early stage in its development, prospective randomized studies can be done by those skilled in the technique; I would encourage these pioneers to seek Level I answers.

http://www.medicalnewstoday.com/articles/172486.php

This article describes a new way to perform laproscopic procedures. The new method is called LESS and is even less invasive than standard laproscopic procedures for the patient. The hope is that it will become more mainstream and also has the potential to become less expensive than standard laproscopic procedures. I was interested in this article because I have witnessed a laproscopic nephroectomy and observed that even with removing the entire kidney the patient was in the hospital for a a relatively short amount of time. It is amazing how biomedical engineers can make something that is even less invasive that will be cheaper in the long run.