ENDOUROLOGY Laparo-endoscopic single-site surgery: recent advances in urology

Abstract

Significant advances have been achieved in the field of urologic laparo-endoscopic single-site surgery (LESS) since the first reported clinical series in 2007. The aim of the present review paper is to summarize and critically analyze the most recent advances in the field of urologic LESS. A literature review was performed using PubMed to retrieve publications related to LESS in urology over the last two years (from January 2011 to May 2012). In the free-text protocol, the following terms were applied: LESS; single port laparoscopy; single incision laparoscopy. Despite unsolved challenges, LESS can be regarded as an emerging trend in minimally invasive urologic surgery and it has significantly evolved, becoming a widely applicable technique in a relatively short time. Outcomes demonstrate that a broad range of procedures can be effectively and safely done, given a solid laparoscopic surgical background and stringent patient-selection criteria. The recent introduction of a purpose-built instrumentation is likely to further foster the application of robotics to LESS. Further improvements are needed before this technique might reach a widespread adoption. Future advances in the field of robotic technology are expected to overcome the current limitations of LESS.

Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

“…The availability of LLDN has been credited by the United Network for Organ Sharing (UNOS) as a factor driving a significant increase in LDN [ 32 – 34 ]. This is similar to observations made within the field of urology 10–15 years ago, where laparoscopic and open surgery started being performed in cases of prostate cancer [ 35 ]. In the future, it is proposed that these procedures be applied to kidney transplantations via the techniques described in Figure 1 .…”

LESS is more for the patient

“…6 Complications should also be well-identified as some series suggest that they may be more prevalent when LESS is performed compared to standard laparoscopy. 2,3 Finally, the present cohort demonstrates the safety and feasibility of transumbilical LESS in the pediatric urological population. Randomized studies are required to better define the usefulness of LESS as no demonstrated or documented benefits over standard laparoscopic approaches have been reported for the pediatric population.…”

“…The reported procedures are becoming more complex with time, using different types of instruments and devices. [2][3][4] It would be interesting to evaluate whether one specific access port is more suitable for pediatric cases. In the actual report, the authors used three different devices.…”

Endoscopic simple prostatectomy

“…The laparoendoscopic single site (LESS) procedure is also used to remove prostatic adenomas [ 33 , 34 ]. The initial procedures used classical laparoscopic instruments with modifications, including the use of a port device for pre– or transvesical access to the prostate [ 35 – 38 ].…”