Laparoendoscopic single-site surgery in urology

Background: Since its introduction, the role of laparoscopic surgery has grown and it has now become the standard approach for many surgical procedures. The benefits of smaller incisions, improved pain and convalescence, and shorter hospital stays have greatly improved patient care and satisfaction. In an effort to further minimize the morbidity of surgery, laparoendoscopic single-site (LESS) or single-incision laparoscopic surgery (SILS) has emerged. We review the collective experience with this novel technique and share our initial observations and early results. Methods: We performed a literature search to review the published experience with this new technique including the breadth of applications and perioperative outcomes associated with LESS in urology. We also analysed the experience with this emerging technique at our institution. Results: There are numerous variations with regards to nomenclature as well as types of access to the abdominal cavity as it pertains to LESS. Urologic procedures involving single-port access have acceptable operating room time, blood loss, and postoperative pain, which are in line with standard laparoscopic surgical outcomes with the added benefit of improved cosmesis and smaller incisions. Conclusions: Further studies and larger cohorts are needed to assess the real benefit of LESS procedures. The additional learning curve needed to master these techniques may be a barrier to wider acceptance, although improvements in instrumentation are likely to bridge this gap

Current Perspectives in the Use of Molecular Imaging To Target Surgical Treatments for Genitourinary Cancers

Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas

252 robotic partial nephrectomies: Evolving renorrhaphy technique and surgical outcomes at a single institution

Objective: To describe the evolution of robotic partial nephrectomy (PN) technique and to analyze the surgical outcomes in a large single institution experience. Materials and Methods: Retrospective review of our institutional review boardapproved, prospectively maintained, minimally invasive PN database yielded 252 robotic partial nephrectomy (RPN) procedures from June 2007 to October 2010. Our initial experience, adopted from our laparoscopic PN approach included a standard interrupted bolstered renorrhaphy, whereas our contemporary experience included a nonbolstered continuous horizontal mattress stitch for the capsular closure. Perioperative results were evaluated depending on renorrhaphy technique, length of warm ischemia time, and nephrometry scores. Results: Overall, mean tumor size was 3.1 ± 1.6 cm, operative time 190 ± 56 minutes, warm ischemia time 18.2 ± 9.4 minutes, and estimated blood loss 267 ± 275 mL. Significantly better outcomes were noted in the contemporary experience in terms of transfusion rate (8.2% vs 21.9%, P <.001), operative time (181 vs 219 minutes, P <.001), hospital stay (3.6 vs 4.3 days, P =.02), and complication rate (14.4% vs 33.8%, P <.01). Increasing tumor complexity based on RENAL score predicted longer operative time (P <.0001), warm ischemia time (P <.0001), and hospital stay (P <.04), and a greater risk of postoperative complications (P =.003). Of the series, only 2 patients had hemorrhagic complications (0.8%) requiring angioembolization, 4 patients developed urine leaks (1.5%), and 2 positive margins (0.8%) were noted. Conclusion: We report the largest single-institution study with RPN to date. Despite it being a relatively nascent procedure, initial results suggest that RPN is an effective approach for minimally invasive nephron-sparing surgery. As experience is gained and the technique for RPN evolves, further improvement in outcomes will be noted. © 2011 Elsevier Inc