Laparoendoscopic single-site surgery and cancer

Abstract

Objectives: To perform a survey of the current state of laparoendoscopic single-site surgery (LESS) and its implementation in the treatment of malignant disease of the urinary tract. Although it is a recent development in the field of laparoscopic surgery with still unproven long-term results, LESS may prove to be more commonly performed in the coming years while managing urologic cancer patients.

Materials and methods: A PubMed search was conducted using the key words laparoendoscopic single-site surgery, LESS, urologic cancer. Relevant articles were reviewed for data on the management of urologic malignancy with LESS.

Results: The first articles describing LESS for urologic cancers were published in 2007. Since then, published experience with this technique has increased. LESS has been implemented as an alternative to conventional laparoscopic surgery and open surgery for the treatment of major urologic cancers. The proposed advantages of LESS are the aesthetic benefit of a single incision and a quicker and less painful recovery. Disadvantages are the lack of instrument triangulation, instrument clashing and the steeper learning curve. As this is a fairly recent technical innovation, long-term functional and oncological results for LESS have not yet been published.

Conclusions: LESS is a novel technical advance over conventional laparoscopic surgery, and it can be successfully used in the treatment of patients with urologic cancers. Published data support the feasibility and safety of LESS interventions for major urologic cancers, and newer data may assist in finding LESS's ultimate position among therapeutic options for patients with urologic malignancies.

Keywords: Laparoendoscopic; laparoendoscopic single-site surgery; laparoscopic surgery; single-site; urologic cancer.

Figure 1

(a) Curved (pre-bent) instruments have been developed in an attempt to improve intra-operative ergonomics. More recently, curved instruments with extra-long shafts have been introduced. These instruments have been used in the performance of hybrid transvaginal laparoendoscopic single-site nephrectomy. The transvaginal access requires instruments with extra-long shafts in order to reach the kidney. (b) Combination of instruments is recommended while performing LESS. A pre-bent instrument provides tissue retraction while a straight instrument is used for dissection

Figure 2

The development of new more advanced ports for single-port access was a signifi cant contribution of LESS in the fi eld of surgical instrumentation. These multi-lumen ports allow the insertion of multiple instruments through the same incision. (a) The Endocone (Karl Storz, Tuttlingen, Germany) multi-lumen port is reusable. (b) The Gelpoint (Applied Medical, Rancho Santa Margarita, CA, USA) is disposable