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.

Keywords: LESS; laparo-endoscopic single-site surgery; robotics; scarless surgery; single-port laparoscopy; urology.

Fig. 1

Reusable access devices for LESS: (a) EndoCone^® (Karl Storz); Keyport^® (Richard Wolf)

Fig. 2

SPIDER system for LESS (Transenterix).

Fig. 3

da Vinci Single Site^® surgery instrumentation (Intuitive Surgical).