Objective: To summarize the technical modification and experiences of transumbilical laparoendoscopic single-site nephrectomy (LESS-N) by homemade device.
Methods: The clinical data of LESS nephrectomy performed from June 2010 to April 2013 in Peking University Third Hospital were analyzed retrospectively. All the cases were divided into two groups according to the technique method and operative date. Group 1 included 10 cases that underwent LESS radical nephrectomy and 2 that received LESS simple nephrectomy from June 2010 to April 2011. Group 2 included 7 cases that underwent LESS radical nephrectomy and 3 that received LESS simple nephrectomy from May 2011 to April 2013. The data on the general presentation, tumor size, tumor location, operative time, blood loss, complications, Visual Analog Pain Scale (VAPS), postoperative hospital stay, pathological results were collected to compare between the two groups. The modified technique included homemade single-ring glove technique, fast access to the pedicle, pulling-up technique to retract the kidney or liver. The kidney was dissociated after the renal vessel was cut off and extracted through the umbilical incision.
Results: All the procedures were finished without conversion to open radical nephrectomy. Compared with group 1, operative time showed significant difference in group 2 [Group 1:(220.6±51.0) min; Group 2: (178.9±34.0) min; P=0.04],and no difference was noted in other factors (P>0.05). There was no secondary bleeding, wound infection, intestinal obstruction, incision hernia and other severe postoperative complications. follow-up of 2 to 36 months showed no local recurrence.
Conclusion: Transumbilical LESS-N is feasible, effective and safe. It gives a more mini-invasive and cosmetic option for young or female patients. Learning curve and operative time can be reduced by modified techniques, such as single-ring glove technique and pulling-up technique.