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TECHNIQUES AND OUTCOMES OF
UROLOGIC LAPAROENDOSCOPIC
SINGLE-SITE SURGERY (LESS):
WORLDWIDE MULTI-INSTITUTIONAL
ANALYSIS OF 1076 CASES
Participating Investigators & Institutions
Jihad H. Kaouk, Riccardo Autorino, Michael A. White, Georges-Pascal Haber, Robert J. Stein,
Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Koon Ho Rha, Jae Won Lee, Woong Kyu Han
Dept of Urology, Yonsei University College of Medicine, Seoul, South Korea
Deok Hyun Han, Byong Chang Jeong
Dept of Urology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
Sun Yinghao, Wang Linhui
Dept of Urology, Changhai Hospital, Shanghai, China
Sara Best, Jeff Cadeddu
Dept of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
Itaar Derweesh, Sean Stroup
Division of Urology, Moores UCSD Cancer Center, La Jolla, CA, USA
Lee Richstone, Soroush Rais-Bahrami
Smith Institute for Urology, NSLIJHS, New Hyde Park, NY, USA
Luca Cindolo, Luigi Schips
Urology Unit, S. Pio da Pietralcina Hospital, Vasto, Italy
Francesco Greco, Paolo Fornara
Dept of Urology & Kidney Transplant, Martin-Luther-University, Halle/Saale, Germany
Mohamad Allaf, Phillip Pierorazio
James B. Brady Urological Institute, Johns Hopkins Institutions, Baltimore, MD, USA
Anibal Branco
Dept of Urology, Cruz Vermelha Hospital and Vita Batel Hospital, Curitiba, Parana, Brazil
Fernando J. Kim
Denver Health Medical Center, University of Colorado, Denver, CO, USA
Wesley M. White
Urology Cancer Center, University of Tennessee Medical Center, Knoxville, TN, USA
Abhay Rane
Dept of Urology, East Surrey Hospital, Redhill, Surrey, UK
René Sotelo, Camilo A. G. Cuevas
Unidad de Urología, Instituto Médico La Floresta, Venezuela
Evangelos Liatsikos
Department of Urology, University of Patras, School of Medicine, Patras, Greece
Jens-Uwe Stolzenburg
Dept of Urology, University of Leipzig, Leipzig, Germany
LESS UROLOGICAL SURGERY: MULTI-INSTITUTIONAL EXPERIENCE
Objectives
• Collaborative effort of investigators from different
Countries
• Reflects a real life scenario at major Institutions who
have pioneered the development of LESS in urology.
 Aim: to provide an analytical overview on
indications, techniques and surgical
outcomes of urologic LESS in a variable
hospital setting worldwide.
Study design
• Patients treated with LESS between August
2007 and December 2010
• 18 participating institutions:
– 14 university/teaching hospitals
– 2 urban public hospitals
– 2 private ones.
• Data retrospectively collected and gathered
into a standardized datasheet
Outcomes analysis
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Demographic data: age, gender, race, BMI, past history of previous abdominal/pelvic surgery,
ASA score, co-morbidities (hypertension, diabetes, renal insufficiency), clinical indication for
LESS procedure.
Procedures categorized as
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“extirpative/ablative” or “reconstructive”
“upper urinary tract” or “pelvic”
on a Likert-type scale from 1 (slightly difficult) to 5 (extremely difficult)
Outcome parameters: OR time, EBL, intraop. adverse events, transfusions, length of stay, VAPS.
Relevant operative data related to the surgical procedure:
– access technique (single-port or single-incision/single-site)
– access site (umbilical or extra-umbilical)
– approach (transperitoneal or retroperitoneal)
– use of articulating/prebent laparoscopic instruments
– use of the da Vinci robotic operating platform (Intuitive Surgical, Sunnyvale, CA)
– type of single-port device
– use of ancillary 2 or 3 mm needlescopic/minilaparoscopic ports.
Conversions
– to reduced port laparoscopy: addition of one extra trocar considered as conversion
– to laparoscopic surgery: unplanned installation of >1 trocar to complete the procedure
– to open surgery: unplanned abdominal incision to perform the operation.
Postoperative complications scored according to Clavien-Dindo classification system.
Conclusions
 The current analysis represents the largest multi-institutional
experience with LESS urologic surgery to date.
 It provides a real life practice picture of what has been done so fare
in this field worldwide.
 LESS in urology has significantly evolved in the last 3 years,
becoming a widely applicable technique in a short time compared
to conventional laparoscopic surgery.
 Outcomes demonstrate that a broad range of urologic procedures
can be effectively and safely done by applying different LESS
techniques in variable hospital settings.
 Undeniably, the use of specific instrumentation available for LESS
and a solid laparoscopic surgical background is critical for a
successful LESS.
 Complications are unlikely if stringent patient selection criteria are
applied.
 Application of robotic technology may further facilitate LESS.