Skip to main content

Advertisement

SpringerLink
Log in

Laparoendoscopic Single-Site Surgery in Kidney Surgery: Clinical Experience and Future Perspectives

  • Surgical Techniques (J Cadeddu and A Stenzl, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Laparoscopic surgery of the upper urinary tract has reduced the morbidity related to large abdominal incisions and has resulted in significant advantages over open surgery. Nevertheless, the pursuit for even more minimally invasive alternatives to laparoscopy has led to the concept of scarless surgery and the approach of laparoendoscopic single-site surgery (LESS). LESS is currently a feasible approach for the majority of kidney surgical procedures, and there is intense debate regarding its efficiency and advantages. In the present review of the literature, the current status of upper urinary LESS and its advantages and disadvantages, as well the technological and technical evolution, are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Clayman RV, Kavoussi LR, Figenshau RS, et al. Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg. 1991;1(6):343–9.

    Article  PubMed  CAS  Google Scholar 

  2. MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol. 2012;61(5):972–93.

    Article  PubMed  Google Scholar 

  3. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery White Paper October. Gastrointest Endosc. 2006;63(2):199–203.

    Article  Google Scholar 

  4. Box G, Averch T, Cadeddu J, et al. Nomenclature of natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) procedures in urology. J Endourol. 2008;22(11):2575–81.

    Article  PubMed  Google Scholar 

  5. Raman JD, Bensalah K, Bagrodia A, et al. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology. 2007;70(6):1039–42.

    Article  PubMed  Google Scholar 

  6. Liatsikos E, Kallidonis P, Kyriazis I, et al. Urologic laparoendoscopic single-site surgery. Nat Rev Urol. 2009;6(12):654–9.

    Article  PubMed  Google Scholar 

  7. Kaouk JH, Autorino R. Laparoendoscopic Single-site Surgery (LESS) and Nephrectomy: Current Evidence and Future Perspectives. Eur Urol. 2012;62(4):613–5.

    Article  PubMed  Google Scholar 

  8. Kaouk JH, Goel RK, Haber G-P, et al. Robotic single-port transumbilical surgery in humans: initial report. BJU Int. 2009;103(3):366–9.

    Article  PubMed  Google Scholar 

  9. •• Kaouk JH, Autorino R, Kim FJ, et al. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol. 2011;60(5):998–1005. This is the first series with more than 1,000 cases.

    Article  PubMed  Google Scholar 

  10. Kommu SS, Rané A. Devices for laparoendoscopic single-site surgery in urology. Expert Rev Med Devices. 2009;6(1):95–103.

    Article  PubMed  Google Scholar 

  11. Liatsikos E, Kallidonis P, Do M, et al. LESS nephrectomy: technique and outcomes. Arch Esp Urol. 2012;65(3):294–302.

    PubMed  Google Scholar 

  12. • Stolzenburg J-U, Kallidonis P, Oh M-A, et al. Comparative assessment of laparoscopic single-site surgery instruments to conventional laparoscopic in laboratory setting. J Endourol. 2010;24(2):239–45. The first study to compare the two categories of instruments in a laboratory setting.

    Article  PubMed  Google Scholar 

  13. • Kaouk JH, Khalifeh A, Laydner H, et al. Transvaginal hybrid natural orifice transluminal surgery robotic donor nephrectomy: first clinical application. Urology. 2012;80(6):1171–5. The first transvaginal NOTES robotic donor nephrectomy.

    Article  PubMed  Google Scholar 

  14. Vricella GJ, Ross JH, Vourganti S, Cherullo EE. Laparoendoscopic single-site nephrectomy: initial clinical experience in children. J Endourol. 2010;24(12):1957–61.

    Article  PubMed  Google Scholar 

  15. Afaneh C, Ramasamy R, Leeser DB, et al. Is right-sided laparoendoscopic single-site donor nephrectomy feasible? Urology. 2011;77(6):1365–9.

    Article  PubMed  Google Scholar 

  16. Gimenez E, Leeser DB, Wysock JS, et al. Laparoendoscopic single site live donor nephrectomy: initial experience. J Urol. 2010;184(5):2049–53.

    Article  PubMed  Google Scholar 

  17. Sanchez-Salas R, Barret E, Cathelineau X. Technology development for laparo-endoscopic single site surgery: from Keypoint to QuadPort+. Future Oncol. 2011;7(12):1365–7.

    Article  PubMed  Google Scholar 

  18. • Schwentner C, Todenhöfer T, Seibold J, et al. Upper urinary tract laparoendoscopic single-site surgery based on a novel cost-effective reusable platform. J Endourol. 2013;27(2):202–7. This is a good study that investigates the issue of cost effectiveness.

    Article  PubMed  Google Scholar 

  19. Friedersdorff F, Aghdassi SJ, Werthemann P, et al. Laparoendoscopic single-site (LESS) varicocelectomy with reusable components: comparison with the conventional laparoscopic technique. SurgEndosc. 2013 Apr 3.

  20. Jeong CW, Kim SH, Kim HT, et al. Insufficient Joint Forces of First-Generation Articulating Instruments for Laparoendoscopic Single-Site Surgery. SurgInnov. 2012 Dec 14.

  21. Fiori C, Morra I, Bertolo R, et al. Standard vs mini-laparoscopic pyeloplasty: perioperative outcomes and cosmetic results. BJU Int. 2013;111(3 Pt B):E121–6.

    Article  PubMed  Google Scholar 

  22. Krpata DM, Ponsky TA. Needlescopic surgery: what’s in the toolbox? SurgEndosc. 2013;27(3):1040–4.

    Google Scholar 

  23. Porpiglia F, Morra I, Bertolo R, et al. Pure mini-laparoscopic transperitoneal pyeloplasty in an adult population: feasibility, safety, and functional results after one year of follow-up. Urology. 2012;79(3):728–32.

    Article  PubMed  Google Scholar 

  24. Pini G, Rassweiler J. Minilaparoscopy and laparoendoscopic single-site surgery: mini- and single-scar in urology. Minim Invasive Ther Allied Technol. 2012;21(1):8–25.

    Article  PubMed  Google Scholar 

  25. Leveillee RJ, Castle SM, Gorin MA, et al. Initial experience with laparoendoscopic single-site simple nephrectomy using the TransEnterix SPIDER surgical system: assessing feasibility and safety. J Endourol. 2011;25(6):923–5.

    Article  PubMed  Google Scholar 

  26. Haber G-P, Autorino R, Laydner H, et al. SPIDER surgical system for urologic procedures with laparoendoscopic single-site surgery: from initial laboratory experience to first clinical application. Eur Urol. 2012;61(2):415–22.

    Article  PubMed  Google Scholar 

  27. Park S, Bergs RA, Eberhart R, et al. Trocar-less instrumentation for laparoscopy: magnetic positioning of intra-abdominal camera and retractor. Ann Surg. 2007;245(3):379–84.

    Article  PubMed  Google Scholar 

  28. • Han WK, Tan YK, Olweny EO, et al. Comparison between magnetic anchoring and guidance system camera-assisted laparoendoscopic single-site surgery nephrectomy and conventional laparoendoscopic single-site surgery nephrectomy in a porcine model: focus on ergonomics and workload profiles. J Endourol. 2013;27(4):490–6. This study proves that MAGS reduces the workload.

    Article  PubMed  Google Scholar 

  29. Yin G, Han WK, Faddegon S, et al. Laparoendoscopic single site (LESS) in vivo suturing using a magnetic anchoring and guidance system (MAGS) camera in a porcine model: impact on ergonomics and workload. Urology. 2013;81(1):80–4.

    Article  PubMed  Google Scholar 

  30. • Best SL, Bergs R, Scott DJ, et al. Solo surgeon laparo-endoscopic single site nephrectomy facilitated by new generation magnetically anchored and guided systems camera. J Endourol. 2012;26(3):214–8. In this study, it is shown that MAGS can replace the assistant who holds the camera.

    Article  PubMed  Google Scholar 

  31. Haber G-P, White MA, Autorino R, et al. Novel robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology. 2010;76(6):1279–82.

    Article  PubMed  Google Scholar 

  32. Kaouk JH, Autorino R, Laydner H, et al. Robotic single-site kidney surgery: evaluation of second-generation instruments in a cadaver model. Urology. 2012;79(5):975–9.

    Article  PubMed  Google Scholar 

  33. Eisenberg D, Vidovszky TJ, Lau J, et al. Comparison of robotic and laparoendoscopic single-site surgery systems in a suturing and knot tying task. SurgEndosc. 2013 Feb 27.

  34. Seo IY, Lee JW, Rim JS. Laparoendoscopic single-site radical nephrectomy: a comparison with conventional laparoscopy. J Endourol. 2011;25(3):465–9.

    Article  PubMed  Google Scholar 

  35. Bazzi WM, Stroup SP, Kopp RP, et al. Comparison of laparoendoscopic single-site and multiport laparoscopic radical and partial nephrectomy: a prospective, nonrandomized study. Urology. 2012;80(5):1039–45.

    Article  PubMed  Google Scholar 

  36. Greco F, Veneziano D, Wagner S, et al. Laparoendoscopic Single-Site Radical Nephrectomy for Renal Cancer: Technique and Surgical Outcomes. Eur Urol. 2012;62(1):168–74.

    Article  PubMed  Google Scholar 

  37. Greco F, Hoda MR, Mohammed N, et al. Laparoendoscopic single-site and conventional laparoscopic radical nephrectomy result in equivalent surgical trauma: preliminary results of a single-centre retrospective controlled study. Eur Urol. 2012;61(5):1048–53.

    Article  PubMed  Google Scholar 

  38. Rosoff JS, Fine RG, Velez MC, Del Pizzo JJ. Laparoendoscopic single-site radical nephrectomy for large renal masses. J Endourol. 2013;27(1):34–9.

    Article  PubMed  Google Scholar 

  39. Springer C, Inferrera A, Kawan F, et al. Laparoendoscopic single-site versus conventional laparoscopic radical nephrectomy for renal cell cancer in patients with increased comorbidities and previous abdominal surgery: preliminary results of a single-centre retrospective study. World J Urol. 2013;31(1):213–8.

    Article  PubMed  Google Scholar 

  40. Dong J, Zu Q, Shi L, et al. Retroperitoneal Laparoendoscopic Single-Site Radical Nephrectomy Using a Low-cost, Self-Made Device: Initial Experience With 29 Cases. SurgInnov. 2012 Dec 4;

  41. Park YH, Baik KD, Lee YJ, et al. Learning curve analysis for laparoendoscopic single-site radical nephrectomy. J Endourol. 2012;26(5):494–8.

    Article  PubMed  Google Scholar 

  42. Kim PH, Patil MB, Kim SS, et al. Early comparison of nephrectomy options in children (open, transperitoneal laparoscopic, laparo-endoscopic single site (LESS), and robotic surgery). BJU Int. 2012;109(6):910–5.

    Article  PubMed  Google Scholar 

  43. • Tugcu V, Ilbey YO, Mutlu B, Tasci AI. Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol. 2010;24(8):1315–20. The first randomized prospective study about nephrectomy.

    Article  PubMed  Google Scholar 

  44. Andonian S, Rais-Bahrami S, Atalla MA, et al. Laparoendoscopic single-site Pfannenstiel versus standard laparoscopic donor nephrectomy. J Endourol. 2010;24(3):429–32.

    Article  PubMed  Google Scholar 

  45. Stamatakis L, Mercado MA, Choi JM, et al. Comparison of laparoendoscopic single site (LESS) and conventional laparoscopic donor nephrectomy at a single institution. BJU Int. 2013 Mar 11;

  46. • Wang GJ, Afaneh C, Aull M, et al. Laparoendoscopic Single Site Live Donor Nephrectomy: Single Institution Report of Initial 100 Cases. J Urol. 2011;186(6):2333–7. First publication with 100 cases of LESS donor nephrectomy.

    Article  PubMed  Google Scholar 

  47. Kaouk JH, Goel RK. Single-port laparoscopic and robotic partial nephrectomy. Eur Urol. 2009;55(5):1163–9.

    Article  PubMed  Google Scholar 

  48. Han WK, Kim DS, Jeon HG, et al. Robot-assisted laparoendoscopic single-site surgery: partial nephrectomy for renal malignancy. Urology. 2011;77(3):612–6.

    Article  PubMed  Google Scholar 

  49. Rais-Bahrami S, George AK, Montag S, et al. Laparoendoscopic single-site (LESS) partial nephrectomy short-term outcomes. BJU Int. 2013;111(2):264–70.

    Article  PubMed  Google Scholar 

  50. Abouassaly R, Alibhai SMH, Tomlinson G, et al. Unintended Consequences of Laparoscopic Surgery on Partial Nephrectomy for Kidney Cancer. J Urol. 2010;183(2):467–72.

    Article  PubMed  Google Scholar 

  51. Bazzi WM, Allaf ME, Berkowitz J, et al. Multicenter experience with nonischemic multiport laparoscopic and laparoendoscopic single-site partial nephrectomy utilizing bipolar radiofrequency ablation coagulator. DiagnTherEndosc. 2011;2011:636537.

    Google Scholar 

  52. •• Greco F, Autorino R, Rha KH, et al. Laparoendoscopic Single-site Partial Nephrectomy: A Multi-institutional Outcome Analysis. Eur Urol. 2013. doi:10.1016/j.eururo.2013.01.025. A large-volume study about LESS partial nephrectomy.

    Google Scholar 

  53. Razzak M. Small renal masses: Jury still out on robotic partial nephrectomy. Nat Rev Urol. 2013;10(5):250.

    Article  PubMed  Google Scholar 

  54. Lin Y-K, Raman JD. Small renal masses: Is LESS partial nephrectomy feasible for most urologists? Nat Rev Urol 2013 in press

  55. Autorino R, Kaouk JH, Yakoubi R, et al. Urological laparoendoscopic single site surgery: multi-institutional analysis of risk factors for conversion and postoperative complications. J Urol. 2012;187(6):1989–94.

    Article  PubMed  Google Scholar 

  56. •• Fan X, Lin T, Xu K, et al. Laparoendoscopic Single-Site Nephrectomy Compared with Conventional Laparoscopic Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol. 2012;62(4):601–12. The first meta-analysis of studies about LESS nephrectomy.

    Article  PubMed  Google Scholar 

  57. Ponsky LE, Steinway ML, Lengu IJ, et al. A Pfannenstiel Single-site Nephrectomy and Nephroureterectomy: A Practical Application of Laparoendoscopic Single-site Surgery. Urology. 2009;74(3):482–5.

    Article  PubMed  Google Scholar 

  58. Rais-Bahrami S, Kavoussi LR, Richstone L. Laparoendoscopic single site (LESS) nephroureterectomy: an overview of techniques & outcomes. Arch Esp Urol. 2012;65(3):311–7.

    PubMed  Google Scholar 

  59. •• Park SY, Rha KH, Autorino R, et al. Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: outcomes of an international multi-institutional study of 101 patients. BJU Int. 2013. doi:10.1111/j.1464-410X.2012.11775.x. The first study of LESS nephroureterectomy with more than 100 patients.

    Google Scholar 

  60. Desai MM, Berger AK, Brandina R, et al. Laparoendoscopic single-site surgery: initial hundred patients. Urology. 2009;74(4):805–12.

    Article  PubMed  Google Scholar 

  61. White WM, Haber G-P, Goel RK, et al. Single-port urological surgery: single-center experience with the first 100 cases. Urology. 2009;74(4):801–4.

    Article  PubMed  Google Scholar 

  62. Choi KH, Ham WS, Rha KH, et al. Laparoendoscopic single-site surgeries: a single-center experience of 171 consecutive cases. Korean J Urol. 2011;52(1):31–8.

    Article  PubMed  Google Scholar 

  63. Khanna R, Isac W, Laydner H, et al. Laparoendoscopic single site reconstructive procedures in urology: medium term results. J Urol. 2012;187(5):1702–6.

    Article  PubMed  Google Scholar 

  64. Tracy CR, Raman JD, Bagrodia A, Cadeddu JA. Perioperative outcomes in patients undergoing conventional laparoscopic versus laparoendoscopic single-site pyeloplasty. Urology. 2009;74(5):1029–34.

    Article  PubMed  Google Scholar 

  65. Tugcu V, Ilbey YO, Sonmezay E, Aras B, Tasci AI. Laparoendoscopic single-site versus conventional transperitoneal laparoscopic pyeloplasty: A prospective randomized study. Int J Urol. 2013 in press.

  66. Olweny EO, Park SK, Tan YK, et al. Perioperative comparison of robotic assisted laparoendoscopic single-site (LESS) pyeloplasty versus conventional LESS pyeloplasty. Eur Urol. 2012;61(2):410–4.

    Article  PubMed  Google Scholar 

  67. Harrow BR, Bagrodia A, Olweny EO, et al. Renal Function Outcomes Following Laparoendoscopic Single-Site (LESS) Pyeloplasty. J. Urol. 2013 Feb 27;

  68. Liu C, Pan B, Zheng S, Xu A. Laparoendoscopic single-site surgery for symptomatic renal cyst decortication using a homemade glove port device: initial experience. Urol Int. 2012;89(2):180–4.

    Article  PubMed  Google Scholar 

  69. Georgiou AN, Rassweiler J, Herrmann TR, et al. Evolution and simplified terminology of natural orifice transluminal endoscopic surgery (NOTES), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). World J Urol. 2012;30(5):573–80.

    Article  PubMed  CAS  Google Scholar 

  70. Sotelo R, de Andrade R, Fernández G, Ramirez D, Di Grazia E, et al. NOTES hybrid transvaginal radical nephrectomy for tumor: stepwise progression toward a first successful clinical case. Eur Urol. 2010;57(1):138–44.

    Article  PubMed  Google Scholar 

  71. Kaouk JH, Haber GP, Goel RK, Crouzet S, Brethauer S, et al. Pure natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy. Eur Urol. 2010;57(4):723–6.

    Article  PubMed  Google Scholar 

  72. Alcaraz A, Peri L, Molina A, Goicoechea I, García E, Izquierdo L, et al. Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy. Eur Urol. 2010;57(2):233–7.

    Article  PubMed  Google Scholar 

  73. Alcaraz A, Musquera M, Peri L, et al. Feasibility of transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy: is kidney vaginal delivery the approach of the future? Eur Urol. 2011;59(6):1019–25.

    Article  PubMed  Google Scholar 

  74. Autorino R, Kim FJ, Rassweiler J, et al. Mini-laparoscopy, laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery-assisted laparoscopy: novice surgeons’ performance and perception in a porcine nephrectomy model. BJU Int. 2012;110(11 Pt C):E991–6.

    Article  PubMed  Google Scholar 

  75. Lima E, Rolanda C, Correia-Pinto J. Transvesical route for NOTES urological applications: advances & controversies. Arch Esp Urol. 2012;65(3):385–92.

    PubMed  Google Scholar 

  76. Lima E, Branco F, Parente J, et al. Transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney morcellation: a proof of concept study. BJU Int. 2012;109(10):1533–7.

    Article  PubMed  Google Scholar 

  77. Bazzi WM, Stroup SP, Cohen SA, et al. Feasibility of transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in the cadaveric model. Urology. 2012;80(3):590–5.

    Article  PubMed  Google Scholar 

  78. Liatsikos E, Kyriazis I, Kallidonis P, et al. Pure single-port laparoscopic surgery or mix of techniques? World J Urol. 2012;30(5):581–7.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Panagiotis Kallidonis reported no potential conflicts of interest relevant to this article.

Dr. Stavros Kontogiannis reported no potential conflicts of interest relevant to this article.

Dr. Iason Kyriazis reported no potential conflicts of interest relevant to this article.

Dr. Ioannis Georgiopoulos reported no potential conflicts of interest relevant to this article.

Dr. Abdulrahman Al-Aown reported no potential conflicts of interest relevant to this article.

Dr. Jens-Uwe Stolzenburg reported no potential conflicts of interest relevant to this article.

Dr. Evangelos Liatsikos reported no potential conflicts of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Urology, University of Patras, Rion, 26 504, Patras, Greece

    Panagiotis Kallidonis, Stavros Kontogiannis, Iason Kyriazis, Ioannis Georgiopoulos, Abdulrahman Al-Aown & Evangelos Liatsikos

  2. Department of Urology, University of Leipzig, Leipzig, Germany

    Jens-Uwe Stolzenburg & Evangelos Liatsikos

Authors
  1. Panagiotis Kallidonis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stavros Kontogiannis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Iason Kyriazis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ioannis Georgiopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abdulrahman Al-Aown
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jens-Uwe Stolzenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Evangelos Liatsikos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Evangelos Liatsikos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kallidonis, P., Kontogiannis, S., Kyriazis, I. et al. Laparoendoscopic Single-Site Surgery in Kidney Surgery: Clinical Experience and Future Perspectives. Curr Urol Rep 14, 496–505 (2013). https://doi.org/10.1007/s11934-013-0346-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-013-0346-5

Keywords

Search

Navigation