Minimally invasive nephrectomy: The influence of laparoendoscopic single-site surgery on patient selection, outcomes, and morbidity

Objectives To define clinical scenarios in urology for which laparoendoscopic single-site surgery (LESS) is indicated and likely to be successful. We report a series of LESS nephrectomies and compare patient characteristics with traditional laparoscopic nephrectomies performed during the same time period. Methods We retrospectively reviewed all laparoscopic nephrectomies (conventional or LESS) performed by a single surgeon at our institution since our initial LESS cases in August 2007. Patients were not randomized; instead the surgeon used clinical judgment to decide with the patient which procedure should be performed. Factors that may have influenced this decision were retrospectively analyzed. Results Of all minimally invasive nephrectomies, 47% were performed using LESS technique (30/64). One conversion from LESS to standard laparoscopy occurred. Patients undergoing LESS had a smaller median age (47 vs 63.5 years, P = .004), body mass index (24.4 vs 28.4, P = .001), tumor size in nephrectomies performed for suspected malignancy (4 cm vs 6 cm, P = .043), and hospital length of stay (42.7 vs 46.1 hours, P = .006). LESS patients were also more likely to be undergoing a nephrectomy for a benign indication (50% vs 15%, P = .006). The complication rate for LESS and conventional laparoscopy was 13% (4/30) and 15% (5/34), respectively, with similar distributions across Clavien grades. Conclusions With appropriate patient selection, almost 50% of minimally invasive nephrectomies can be performed using LESS with similar complication rates and outcomes compared with traditional laparoscopy. Younger, thinner patients with nononcological indications or smaller tumors are prime candidates for LESS nephrectomy.