Do we need a cosmetic effect for radical nephrectomy?  Laparoendoscopic single-site surgery would help to answer this question

Piotr Chłosta; Tomasz Drewa; Mateusz Obarzanowski; Artur Antoniewicz; Andrzej Borówka

doi:10.5114/wiitm.2011.20985

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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abstract:

Original paper

Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question

Piotr Chłosta

,

Tomasz Drewa

,

Mateusz Obarzanowski

,

Artur Antoniewicz

,

Andrzej Borówka

Videosurgery and other miniinvasive techniques 2011; 6 (1): 1-4

DOI: https://doi.org/10.5114/wiitm.2011.20985

Online publish date: 2011/03/29

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Introduction: The development of endovision techniques and equipment miniaturization in urology make it possible to perform laparoendoscopic single-site (LESS) nephrectomy. Radical nephrectomy due to renal cancer performed with LESS is not a standard procedure in urology.

Aim: To present our preliminary results and operative technique of LESS radical nephrectomy.

Material and methods: The study was carried out after team experience based on LESS radical nephrectomy performed from October 2009 to June 2010 in 11 cases. A single port with 3 working channels (Triport Access System, OLYMPUS®) and a 5 mm laparoscope 30° were used. The approach was created by minilaparotomy technique on the lateral margin of the rectus muscle, 4 cm above the umbilicus. The procedure was performed using standard laparoscopic instruments, bent or articulating graspers, and scissors. During the surgery metal and plastic clips were used, and a mechanical vascular stapler in two cases. In every case bipolar coagulation was used. The postoperative specimen was removed via single-port minilaparotomy. After surgery, one suction drain 14 F was left.

Results: In all patients the procedure was performed without conversion to standard, open technique. In two cases accessory port (10 and 12 mm) placement was necessary, for organ retraction or insertion of a vascular stapler. Mean surgery time was 128 min (120-160 min). Mean blood loss was 155 ml (100-250 ml). There were no complications during surgery or the postoperative period. Mean hospitalization stay was 4 days (3-5 days). Clinical stage of renal cell cancer (RCC) was pT1a in 1, pT1b in 9, and pT3a in 1 patient. The results of histopathological examination show typical RCC in 10 cases, and papillary RCC in 1.

Conclusions: LESS nephrectomy is effective but technically difficult. LESS nephrectomy is a considerably less invasive procedure than standard laparoscopic nephrectomy, unless accessory port placement is necessary. LESS offers a very good cosmetic effect, which can be an attribute of the single-site approach. LESS radical nephrectomy makes it possible to perform efficient and safe kidney excision and seems to be a valuable alternative to classic surgery in properly selected cases.

keywords:

Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question

Piotr Chłosta , Tomasz Drewa , Mateusz Obarzanowski , Artur Antoniewicz , Andrzej Borówka

laparoendoscopic single-site surgery, laparoscopy, radical nephrectomy

Piotr Chłosta

,

Tomasz Drewa

,

Mateusz Obarzanowski

,

Artur Antoniewicz

,

Andrzej Borówka