Laparoendoscopic single-site surgery in urology: Worldwide multi-institutional analysis of 1076 cases

Jihad H. Kaouk, Riccardo Autorino, Fernando J. Kim, Deok Hyun Han, Seung Wook Lee, Sun Yinghao, Jeffrey A. Cadeddu, Ithaar H. Derweesh, Lee Richstone, Luca Cindolo, Anibal Branco, Francesco Greco, Mohamad Allaf, René Sotelo, Evangelos Liatsikos, Jens Uwe Stolzenburg, Abhay Rane, Wesley White, Woong Kyu Han, Georges Pascal HaberMichael A. White, Wilson R. Molina, Byong Chang Jeong, Joo Yong Lee, Wang Linhui, Sara Best, Sean P. Stroup, Soroush Rais-Bahrami, Luigi Schips, Paolo Fornara, Phillip Pierorazio, Camilo Giedelman, Jae Won Lee, Robert J. Stein, Koon Ho Rha

Research output: Contribution to journalArticle

211 Citations (Scopus)

Abstract

Background: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective: To report a large multi-institutional worldwide series of LESS in urology. Design, setting, and participants: Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Intervention: Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Measurements: Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Results and limitations: Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160 ± 93 min and estimated blood loss was 148 ± 234 ml. Skin incision length at closure was 3.5 ± 1.5 cm. Mean hospital stay was 3.6 ± 2.7 d with a visual analog pain score at discharge of 1.5 ± 1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. Conclusions: This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.

Original languageEnglish (US)
Pages (from-to)998-1005
Number of pages8
JournalEuropean Urology
Volume60
Issue number5
DOIs
StatePublished - Nov 1 2011

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Urology
Laparoscopy
Intraoperative Complications
Patient Selection
Umbilicus
Minimally Invasive Surgical Procedures
Robotics
Operative Time
Urinary Tract
Length of Stay
Demography
Delivery of Health Care
Pain
Skin

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Kaouk, J. H., Autorino, R., Kim, F. J., Han, D. H., Lee, S. W., Yinghao, S., ... Rha, K. H. (2011). Laparoendoscopic single-site surgery in urology: Worldwide multi-institutional analysis of 1076 cases. European Urology, 60(5), 998-1005. https://doi.org/10.1016/j.eururo.2011.06.002

Laparoendoscopic single-site surgery in urology : Worldwide multi-institutional analysis of 1076 cases. / Kaouk, Jihad H.; Autorino, Riccardo; Kim, Fernando J.; Han, Deok Hyun; Lee, Seung Wook; Yinghao, Sun; Cadeddu, Jeffrey A.; Derweesh, Ithaar H.; Richstone, Lee; Cindolo, Luca; Branco, Anibal; Greco, Francesco; Allaf, Mohamad; Sotelo, René; Liatsikos, Evangelos; Stolzenburg, Jens Uwe; Rane, Abhay; White, Wesley; Han, Woong Kyu; Haber, Georges Pascal; White, Michael A.; Molina, Wilson R.; Jeong, Byong Chang; Lee, Joo Yong; Linhui, Wang; Best, Sara; Stroup, Sean P.; Rais-Bahrami, Soroush; Schips, Luigi; Fornara, Paolo; Pierorazio, Phillip; Giedelman, Camilo; Lee, Jae Won; Stein, Robert J.; Rha, Koon Ho.

In: European Urology, Vol. 60, No. 5, 01.11.2011, p. 998-1005.

Research output: Contribution to journalArticle

Kaouk, JH, Autorino, R, Kim, FJ, Han, DH, Lee, SW, Yinghao, S, Cadeddu, JA, Derweesh, IH, Richstone, L, Cindolo, L, Branco, A, Greco, F, Allaf, M, Sotelo, R, Liatsikos, E, Stolzenburg, JU, Rane, A, White, W, Han, WK, Haber, GP, White, MA, Molina, WR, Jeong, BC, Lee, JY, Linhui, W, Best, S, Stroup, SP, Rais-Bahrami, S, Schips, L, Fornara, P, Pierorazio, P, Giedelman, C, Lee, JW, Stein, RJ & Rha, KH 2011, 'Laparoendoscopic single-site surgery in urology: Worldwide multi-institutional analysis of 1076 cases', European Urology, vol. 60, no. 5, pp. 998-1005. https://doi.org/10.1016/j.eururo.2011.06.002
Kaouk, Jihad H. ; Autorino, Riccardo ; Kim, Fernando J. ; Han, Deok Hyun ; Lee, Seung Wook ; Yinghao, Sun ; Cadeddu, Jeffrey A. ; Derweesh, Ithaar H. ; Richstone, Lee ; Cindolo, Luca ; Branco, Anibal ; Greco, Francesco ; Allaf, Mohamad ; Sotelo, René ; Liatsikos, Evangelos ; Stolzenburg, Jens Uwe ; Rane, Abhay ; White, Wesley ; Han, Woong Kyu ; Haber, Georges Pascal ; White, Michael A. ; Molina, Wilson R. ; Jeong, Byong Chang ; Lee, Joo Yong ; Linhui, Wang ; Best, Sara ; Stroup, Sean P. ; Rais-Bahrami, Soroush ; Schips, Luigi ; Fornara, Paolo ; Pierorazio, Phillip ; Giedelman, Camilo ; Lee, Jae Won ; Stein, Robert J. ; Rha, Koon Ho. / Laparoendoscopic single-site surgery in urology : Worldwide multi-institutional analysis of 1076 cases. In: European Urology. 2011 ; Vol. 60, No. 5. pp. 998-1005.
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abstract = "Background: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective: To report a large multi-institutional worldwide series of LESS in urology. Design, setting, and participants: Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Intervention: Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Measurements: Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Results and limitations: Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13{\%}). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160 ± 93 min and estimated blood loss was 148 ± 234 ml. Skin incision length at closure was 3.5 ± 1.5 cm. Mean hospital stay was 3.6 ± 2.7 d with a visual analog pain score at discharge of 1.5 ± 1.4. An additional port was used in 23{\%} of cases. The overall conversion rate was 20.8{\%}; 15.8{\%} of patients were converted to reduced-port laparoscopy, 4{\%} to conventional laparoscopy/robotic surgery, and 1{\%} to open surgery. The intraoperative complication rate was 3.3{\%}. Postoperative complications, mostly low grade, were encountered in 9.5{\%} of cases. Conclusions: This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.",
author = "Kaouk, {Jihad H.} and Riccardo Autorino and Kim, {Fernando J.} and Han, {Deok Hyun} and Lee, {Seung Wook} and Sun Yinghao and Cadeddu, {Jeffrey A.} and Derweesh, {Ithaar H.} and Lee Richstone and Luca Cindolo and Anibal Branco and Francesco Greco and Mohamad Allaf and Ren{\'e} Sotelo and Evangelos Liatsikos and Stolzenburg, {Jens Uwe} and Abhay Rane and Wesley White and Han, {Woong Kyu} and Haber, {Georges Pascal} and White, {Michael A.} and Molina, {Wilson R.} and Jeong, {Byong Chang} and Lee, {Joo Yong} and Wang Linhui and Sara Best and Stroup, {Sean P.} and Soroush Rais-Bahrami and Luigi Schips and Paolo Fornara and Phillip Pierorazio and Camilo Giedelman and Lee, {Jae Won} and Stein, {Robert J.} and Rha, {Koon Ho}",
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T1 - Laparoendoscopic single-site surgery in urology

T2 - Worldwide multi-institutional analysis of 1076 cases

AU - Kaouk, Jihad H.

AU - Autorino, Riccardo

AU - Kim, Fernando J.

AU - Han, Deok Hyun

AU - Lee, Seung Wook

AU - Yinghao, Sun

AU - Cadeddu, Jeffrey A.

AU - Derweesh, Ithaar H.

AU - Richstone, Lee

AU - Cindolo, Luca

AU - Branco, Anibal

AU - Greco, Francesco

AU - Allaf, Mohamad

AU - Sotelo, René

AU - Liatsikos, Evangelos

AU - Stolzenburg, Jens Uwe

AU - Rane, Abhay

AU - White, Wesley

AU - Han, Woong Kyu

AU - Haber, Georges Pascal

AU - White, Michael A.

AU - Molina, Wilson R.

AU - Jeong, Byong Chang

AU - Lee, Joo Yong

AU - Linhui, Wang

AU - Best, Sara

AU - Stroup, Sean P.

AU - Rais-Bahrami, Soroush

AU - Schips, Luigi

AU - Fornara, Paolo

AU - Pierorazio, Phillip

AU - Giedelman, Camilo

AU - Lee, Jae Won

AU - Stein, Robert J.

AU - Rha, Koon Ho

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Background: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective: To report a large multi-institutional worldwide series of LESS in urology. Design, setting, and participants: Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Intervention: Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Measurements: Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Results and limitations: Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160 ± 93 min and estimated blood loss was 148 ± 234 ml. Skin incision length at closure was 3.5 ± 1.5 cm. Mean hospital stay was 3.6 ± 2.7 d with a visual analog pain score at discharge of 1.5 ± 1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. Conclusions: This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.

AB - Background: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective: To report a large multi-institutional worldwide series of LESS in urology. Design, setting, and participants: Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Intervention: Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Measurements: Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Results and limitations: Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160 ± 93 min and estimated blood loss was 148 ± 234 ml. Skin incision length at closure was 3.5 ± 1.5 cm. Mean hospital stay was 3.6 ± 2.7 d with a visual analog pain score at discharge of 1.5 ± 1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. Conclusions: This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.

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