Laparoendoscopic single-site (LESS) partial nephrectomy short-term outcomes.

Abstract

To present our experience of transumbilical laparoendoscopic single-site (LESS) partial nephrectomy (PN) with pathological and short-term oncological and renal functional outcomes. In all, 15 LESS-PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon. All patients underwent transumbilical LESS using a 5-mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments. The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN. Demographic, perioperative, and postoperative variables were recorded and analysed. Of the 14 patients (eight men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2-4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins. The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0-37) min; bull-dog clamps were used for hilar-control in nine cases with the remaining six cases done without hilar vascular clamping. The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions. The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg. Follow-up surveillance imaging showed no recurrence at a mean (sd, range) follow-up of 18.3 (12.2; 6-36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow-up of 17.1 (11.9; 1-36) months. LESS-PN is a feasible and effective operation, providing complete oncological resection along with excellent short-term oncological and renal functional outcomes.