Editorial Comment to Laparoendoscopic single‐site surgeries: A multicenter experience of 469 cases in Japan

Abstract

The article by Sato et al. presents a multi-institutional study evaluating the surgical outcomes of urological LESS surgery, including the safety and feasibility of the procedure, at nine university centers in Japan. 3 The authors retrospectively presented 469 consecutive patients undergoing LESS surgery for a wide range of urological diseases. According to the authors, the study is the second largest series of diverse LESS urological surgery. The most common procedures were adrenalectomy and nephrectomy (37.7% and 30.5%, respectively). The conversion rate (8.7%), intraoperative complications (2.1%), postoperative complications (6.2%) and median operative time were comparable with other series.1,4 Noteworthy is that at least one additional instrument was used in 28% of patients. Nearly all radical prostatectomy and pyeloplasty procedures required additional miniport or needlescopic instrument. The authors conclude that non-robotic LESS surgery is safe and technically feasible for patients with a broad range of urological diseases, and can be safely carried out by experienced urological surgeons in intermediate-volume centers.Though the presented approach is feasible in urological patients, there are obvious limitations of the study. The retrospective nature of the report, heterogeneity of patients, differences in surgical approaches and instrumentations, and lack of control group limit the value of research. These limitations are acceptable because of the fact that the technique is in its developing stages. The presented data showed that a broad range of procedures can be effectively and safely carried out.LESS as a still emerging surgical technique that requires clinical validation. Introduced advances in surgical technique should be primarily aimed at improving patient safety and outcomes. Further studies have to answer the question as to whether this treatment is less invasive for patients and improves cosmesis, and more importantly, whether introducing the LESS approach would or would not compromise oncological outcomes. Although the feasibility of the LESS technique has been shown, the role of LESS in mini-invasive urological surgery is still not clearly established and, ideally, this advanced approach should be compared with the standard laparoscopy in a prospective, randomized, multicenter trial before gaining general acceptance.