Techniques that attempt to further reduce the morbidity and improve cosmesis of laparoscopic surgery have particularly generated interest. Since its initial urologic description in 2007, there has been a surge of interest in laparoendoscopic single-site surgery, which is now an emerging technique within the field of minimally invasive urologic surgery. This report describes a preliminary experience with single-site video endoscopic inguinal lymphadenectomy (SSVEIL) compared with conventional video endoscopic inguinal lymphadenectomy (VEIL) on inguinal nodes management in a 45-year-old man with pT(2) grade 2 squamous cell penile carcinoma and impalpable inguinal nodes. VEIL with saphenous vein preservation in the left leg and SSVEIL on the other side presented no difference concerning operative time (100 vs 120 min), blood loss (50 mL), drainage volume, number of nodes retrieved (8), pain, and oncologic outcome. The patient had an uneventful postoperative course, was discharged 12 hours after the procedure, and preferred the aesthetic result of SSVEIL. Further refinements in technology will likely alleviate many of the persistent technical problems. Additional rigorous comparison studies are needed to evaluate the true benefits of the technique and the extent of its clinical application, mainly oncologic results, before the widespread adoption of SSVEIL. Ultimately, advance breakthroughs in fields of in-vivo instrumentation, robotics, and purpose-built robotic platforms will bring its potential to full clinical realization.

OBJECTIVE:To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique.BACKGROUND:TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven.PATIENTS AND METHODS:Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon.RESULTS:All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement.CONCLUSION:EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.

Severe urinary incontinence, transfusion and complications rates are related to learning curve which is continuous, although a significant improvement is pragmatic after 70 cases. An intensive mentored training program should be considered to minimize the learning outlays.

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