Preliminary experience with transperitoneal laparoendoscopic single-site radical nephrectomy using a home-made single-port device in China

Background Laparoendoscopic single-site(LESS) surgery represents a technique to further reduce morbidity and scarring associated with surgery. We present our preliminary experience with transperitoneal LESS radical nephrectomy(RN) using a home-made single-port device in China.Methods From July 2010 to November 2011, eleven patients with renal tumor not greater than T2 underwent LESS-RN by an experienced laparoscopic surgeon. A home-made single-port device was used through a 5-cm umbilical incision. A combination of standard and articulating laparoscopic instruments was used. The sequence of steps of LESS-RN was similar to transperitoneal laparoscopic RN. Patient characteristics, perioperative variables and postoperative outcomes were recorded and analyzed.Results Except for two transperitoneal laparoscopic conversions and one hand-assisted laparoscopic conversion, the other procedures were completed successfully without conversion to open surgery. The mean operative time was 224.5(155-297) minutes, estimated blood loss was 270.9(50-900) ml, and hospital stay was 10.4(5-15) days. The mean visual analog pain scale(VAPS) on the first postoperative day was 4.0/10. Final pathological analysis revealed renal cell carcinoma in all cases with a stage distribution of three T1 a, five T1 b, and three T2 a tumors. With the mean followup period of 21.4(12-28) months, all patients were alive without evidence of tumor recurrence or metastasis, and were satisfied with the appearance of the scars.Conclusion Transperitoneal LESS-RN using a home-made single-port device is technically feasible and safe in a selected group of patients(low body mass index and stage tumor) and has excellent cosmetic results. Although preliminary oncologic outcome is not compromised, the long-term evaluation of these patients is awaited.