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Laparoendoscopic single-site surgery in urology: where have we been and where are we heading?

Nature Clinical Practice Urology volume 5, pages 561–568 (2008)Cite this article

Abstract

One-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, urologists have successfully performed various procedures with LESS, including partial nephrectomy, pyeloplasty, orchiectomy, orchiopexy, ureterolithotomy, sacrocolpopexy, renal biopsy, renal cryotherapy, and adrenalectomy. Further advancements in technology, such as magnetic anchoring and guidance systems, and robotic instrumentation, may allow broader application of this emerging surgical technique. Future research is required to determine the intraoperative and postoperative benefits of LESS in comparison with standard laparoscopy.

Key Points

  • Continued advancement in laparoscopy and a desire for less-invasive surgery has led to the development of novel surgical approaches, including natural orifice transluminal endoscopic surgery and laparoendoscopic single-site surgery (LESS)

  • LESS reduces the number of ports necessary to complete laparoscopic surgery and might reduce intraoperative complications and postoperative morbidity

  • Development of single-port access systems and modified bent and articulating instruments have allowed urologists to complete complex reconstructive and oncologic procedures through a single incision

  • Retrospective analysis has not demonstrated a benefit to LESS compared with standard laparoscopy, though prospective randomized trials are necessary to further determine the advantages and disadvantages of this technique

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Figure 1: Illustration of open surgery versus standard laparoscopic surgery for nephrectomy.
Figure 2: The TriPort™.
Figure 3: The extracorporeal view of the Uni-X™.
Figure 4: The transabdominal magnetic anchoring and guidance system (MAGS).
Figure 5: Transumbilical laparoendoscopic single-site surgery.

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References

  1. Clayman RV et al. (1991) Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg 1: 343–349

    Article  CAS  Google Scholar 

  2. Abbou CC et al. (1999) Retroperitoneal laparoscopic versus open radical nephrectomy. J Urol 161: 1776–1780

    Article  CAS  Google Scholar 

  3. Taylor GD and Cadeddu JA (2004) Applications of laparoscopic surgery in urology: impact on patient care. Med Clin North Am 88: 519–538

    Article  Google Scholar 

  4. Gill IS et al. (1995) Advances in urological laparoscopy. J Urol 154: 1275–1294

    Article  CAS  Google Scholar 

  5. Rassweiler J et al. (1998) Nephrectomy: a comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach. Eur Urol 33: 489–496

    Article  CAS  Google Scholar 

  6. Rane A (2002) Laparoscopy in urology: indications and training. BJU Int 90: 142

    Article  CAS  Google Scholar 

  7. Smaldone MC et al. (2007) Laparoscopy in paediatric urology: present status. BJU Int 100: 143–150

    Article  Google Scholar 

  8. Stolzenburg JU et al. (2006) Role of laparoscopy for reconstructive urology. Curr Opin Urol 16: 413–418

    Article  Google Scholar 

  9. Lowry PS et al. (2003) Symptomatic port-site hernia associated with a non-bladed trocar after laparoscopic live-donor nephrectomy. J Endourol 17: 493–494

    Article  Google Scholar 

  10. Marcovici I (2001) Significant abdominal wall hematoma from an umbilical port insertion. JSLS 5: 293–295

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Swain P (2008) Nephrectomy and natural orifice translumenal endoscopy (NOTES): transvaginal, transgastric, transrectal, and transvesical approaches. J Endourol 22: 811–818

    Article  Google Scholar 

  12. Gettman MT and Cadeddu JA (2008) Natural orifice translumenal endoscopic surgery (NOTES) in urology: initial experience. J Endourol 22: 783–788

    Article  Google Scholar 

  13. Haber GP et al. (2008) Robotic NOTES (Natural Orifice Translumenal Endoscopic Surgery) in reconstructive urology: initial laboratory experience. Urology 71: 996–1000

    Article  Google Scholar 

  14. Isariyawongse JP et al. (2008) Pure natural orifice transluminal endoscopic surgery (NOTES) nephrectomy using standard laparoscopic instruments in the porcine model. J Endourol 22: 1087–1091

    Article  Google Scholar 

  15. Gettman MT et al. (2002) Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 59: 446–450

    Article  Google Scholar 

  16. Box GN et al. (2008) Rapid communication: robot-assisted NOTES nephrectomy: initial report. J Endourol 22: 503–506

    Article  Google Scholar 

  17. Clayman RV et al. (2007) Rapid communication: transvaginal single-port NOTES nephrectomy: initial laboratory experience. J Endourol 21: 640–644

    Article  Google Scholar 

  18. Esposito C (1998) One-trocar appendectomy in pediatric surgery. Surg Endosc 12: 177–178

    Article  CAS  Google Scholar 

  19. Piskun G and Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9: 361–364

    Article  CAS  Google Scholar 

  20. Hirano D et al. (2005) Retroperitoneoscopic adrenalectomy for adrenal tumors via a single large port. J Endourol 19: 788–792

    Article  Google Scholar 

  21. Gettman MT et al. (2008) Consensus statement on natural orifice transluminal endoscopic surgery and single-incision laparoscopic surgery: heralding a new era in urology? Eur Urol 6: 1117–1120

    Article  Google Scholar 

  22. Cuesta MA et al. (2007) The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar. Surg Endosc 22: 1211–1213

    Article  Google Scholar 

  23. Zhu JF (2007) Scarless endoscopic surgery: NOTES or TUES. Surg Endosc 21: 1898–1899

    Article  Google Scholar 

  24. Pappalepore N et al. (2002) Transumbilical laparoscopic-assisted appendectomy (TULAA): a safe and useful alternative for uncomplicated appendicitis. Eur J Pediatr Surg 12: 383–386

    Article  CAS  Google Scholar 

  25. Rao P et al. (2008) E-NOTES: A new paradigm: experience in 33 cases. J Urol 179 (Suppl): 238

    Article  Google Scholar 

  26. Raman JD et al. (2007) Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 70: 1039–1042

    Article  Google Scholar 

  27. Rane A et al. (2008) Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port). Urology 72: 260–263

    Article  Google Scholar 

  28. Raman JD et al. (2008) Single-incision laparoscopic surgery: initial urological experience and comparison with natural-orifice transluminal endoscopic surgery. BJU Int 101: 1493–1496

    Article  Google Scholar 

  29. Raman JD et al. (2008) Single incision (keyhole) umbilical urologic surgery: initial clinical experience. J Urol 179 (Suppl): 237–238

    Article  Google Scholar 

  30. Park S et al. (2007) Trocar-less instrumentation for laparoscopy: magnetic positioning of intra-abdominal camera and retractor. Ann Surg 245: 379–384

    Article  Google Scholar 

  31. Zeltser IS et al. (2007) Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model. J Urol 178: 288–291

    Article  Google Scholar 

  32. Rane A et al. (2007) Single port laparoscopic nephrectomy using a novel laparoscopic port (R-port) and evolution of single laparoscopic port procedure (SLIPP). J Endourol 21 (Suppl 1): A1–A292

    Google Scholar 

  33. Ponsky LE et al. (2008) Single access site laparoscopic radical nephrectomy: initial clinical experience. J Endourol 22: 663–666

    Article  Google Scholar 

  34. Zeltser IS and Cadeddu JA (2008) A novel magnetic anchoring and guidance system to facilitate single trocar laparoscopic nephrectomy. Curr Urol Rep 9: 62–64

    Article  Google Scholar 

  35. Desai MM et al. (2008) Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU Int 101: 83–88

    Article  Google Scholar 

  36. Kaouk JH et al. (2008) Single port laparoscopic ablative and reconstructive surgery in urology. J Urol 179 (Suppl): 239

    Article  Google Scholar 

  37. Desai MM et al. (2008) Scarless single port transumbilical advanced laparoscopic surgery: initial report of nephrectomy, pyeloplasty and partial nephrectomy. J Urol 179 (Suppl): 239

    Article  Google Scholar 

  38. Kaouk JH et al. (2008) Single-port laparoscopic surgery in urology. J Urol 179 (Suppl): 306

    Article  Google Scholar 

  39. Raman JD et al.: Single access “keyhole” laparoscopic versus conventional laparoscopic nephrectomy: comparing perioperative outcomes and early convalescence. Eur Urol, in press

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Authors and Affiliations

  1. CR Tracy is an Assistant Professor and JA Cadeddu is an Associate Professor at the Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,

    Chad R Tracy & Jeffrey A Cadeddu

  2. JD Raman is an Assistant Professor at the Division of Urology, Penn State Milton S Hershey Medical Center, Hershey, PA, USA.,

    Jay D Raman

  3. A Rane is a Consultant Urologist at the Department of Urology, East Surrey Hospital, Redhill, UK.,

    Abhay Rane

Authors
  1. Chad R Tracy
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  2. Jay D Raman
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  4. Abhay Rane
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Correspondence to Abhay Rane.

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The authors declare no competing financial interests.

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Tracy, C., Raman, J., Cadeddu, J. et al. Laparoendoscopic single-site surgery in urology: where have we been and where are we heading?. Nat Rev Urol 5, 561–568 (2008). https://doi.org/10.1038/ncpuro1215

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