Background: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective: To report a large multi-institutional worldwide series of LESS in urology. Design, Setting, And Participants: Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Intervention: Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Measurements: Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Results and Limitations: Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160 ± 93 min. and estimated blood loss was 148 ± 234 mL. Skin incision length at closure was 3.5 ± 1.5cm. Mean hospital stay was 3.6 ± 2.7 d with a visual analog pain score at discharge of 1.5 ± 1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/ robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. Conclusions: This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.

Urological laparoendoscopic single site surgery can be done with a low complication rate, resembling that in laparoscopic series. The conversion rate suggests that early adopters of the technique have adhered to the principles of careful patient selection and safety. Besides facilitating future comparisons across institutions, this analysis can be useful to counsel patients on the current risks of urological laparoendoscopic single site surgery.

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Laparoscopic surgery is feasible when anatrophic nephrolithotomy is indicated. This technique minimizes the barriers of an open flank incision, while achieving excellent stone-free rates. This minimally invasive technique should be considered for complex stones that would necessitate multiple renal access tracks and secondary procedures.

Objective• To evaluate the perioperative and pathological outcomes associated with robot-assisted radical prostatectomy (RARP) in morbidly obese men. Patients and Methods• Between January 2008 and March 2012, 3041 patients underwent RARP at our institution by a single surgeon (V.P.). • In all, 44 patients were considered morbidly obese with a body mass index (BMI) of Ն40 kg/m 2 .• A propensity score-matched analysis was conducted using multivariable analysis to identify comparable groups of patients with a BMI of Ն40 and <40 kg/m 2 .• Perioperative, pathological outcomes and complications were compared between the two matched groups. Results• There was no significant difference in operative time. However, the mean estimated blood loss was higher in morbidly obese patients, at a mean (SD) of 113 (41) vs 130 (27) mL (P = 0.049).• Anastomosis was more difficult in morbidly obese patients (P = 0.001).• There were no significant differences in laterality, ease of nerve sparing, or transfusion rate between the groups. • There were no intraoperative complications in either group.Postoperative pathological outcomes were similar between the groups. • Differences in positive surgical margins and ease of nerve sparing approached statistical significance (P = 0.097, P = 0.075 respectively). Postoperative complication rates, pain scores, length of stay and indwelling catheter duration were similar in the groups. Conclusions• RARP in morbidly obese patients is technically demanding. However, it can be accomplished with acceptable morbidity and resource use. • In the hands of an experienced surgeon, it is a safe procedure and offers beneficial clinical outcomes.