Laparoendoscopic single-site pyeloplasty

Abstract

Since the inception of laparoscopic surgery, there has been an ongoing effort to develop an even more 'minimally invasive' approach to surgery. A novel example of such advancement can be found in laparoendoscopic single-site (LESS) surgery. Performing surgery through a single site of access holds the promise of decreased morbidity, lower blood loss, shorter convalescence, and improved cosmesis. Given the nonextirpative nature of the pyeloplasty procedure, this patient cohort has proven to be the ideal candidates for LESS surgery. The driving force behind adaptation of this newer technique can be attributed to innovations in access sites and devices, instrumentation, optics, and robotic-based assistance. There are now several studies in the published literature demonstrating the feasibility and efficacy of LESS pyeloplasty in both children and adults. Although comparative studies have failed to demonstrate any objective advantage of the LESS pyeloplasty operation, it is important to realize that LESS surgery is still a fairly new technique. Further technological developments and additional studies will ultimately define its role in the field of urologic surgery, and subsequently, its application for the pyeloplasty procedure.

Keywords: LESS; laparoscopy; pyeloplasty; single-site surgery.

Figure 1.

A surgeon demonstrates use of the GelPort Device during a laparoendoscopic single-site (LESS) pyeloplasty procedure.

Figure 2.

(A) Trocar orientation for a robotic-assisted laparoendoscopic single-site (R-LESS) procedure. (B) The robotic arms docked during an R-LESS procedure. (C), (D) Intraoperative still photos of an R-LESS pyeloplasty procedure.