Laparoendoscopic single site (LESS) partial nephrectomy

Purpose: Laparoscopic or robotic-assisted partial nephrectomy has gained wider acceptance as a surgical technique in treating small renal tumors. Laparoendoscopic single site partial (LESS) partial nephrectomy is still a technically demanding surgery to this day. We present our technique of LESS partial nephrectomy, one that is performed with limited warm ischemic time.

Materials and Methods: From March 2012 to March 2016, fifteen patients of Kaohsiung Medical University Hospital and Kaohsiung Municipal Ta-Tung Hospital with localized renal parenchymal tumor (stage T1) were included. Our procedure involves the covering of renal defect layer by layer by FloSeal, Tisseel and a fat pad after mono-polar coagulation. Commercial single ports—Lagiport (Lagis, Taiwan) were used in our operation.

Results: Fifteen patients were included in this study. Mean patient age was 61.3 years (range47–76). Mean tumor size was 3.0 cm (range 1.7–6.3). Mean RENAL nephrometry score was 5.1 (range 4–7). The average operation time was 191.0 minutes (range 160–245). The average warm ischemic time was 15.6 minutes (range 9–26). Mean estimated blood loss was 230 ml (range 30–650). No recurrent tumor can be identified at a mean follow-up of 19 months postoperatively.

Conclusion: Our technique has shown to reduce warm ischemic time significantly and provide patients with excellent functional and cosmetic outcomes without impacting oncological results. With this technique, LESS partial nephrectomy will be a safe and effective technique for patients with stage T1 tumor.