La néphrectomie laparoscopique par accès ombilical unique : évolution ou révolution chirurgicale ? [Renal LESS surgery: Slight modification or surgical revolution?].

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Verhoest, Gregory | Patard, Jean-Jacques | Delreux, Arnaud | Crépel, Maxime | Manunta, Andréa | Vincendeau, Sébastien | Guille, François | Bensalah, Karim

Edité par CCSD ; Elsevier Masson -

International audience. OBJECTIVE: to present our initial experience of laparoendoscopic single site (LESS) renal surgery. METHODS: between May 2009 and March 2010, nine nephrectomies and one cyst decortication were performed in nine patients. Eight of the procedures were done with three 5mm trocars inserted through a unique peri-umbilical incision. In two cases, a specific single-port device was used. All operations were achieved with a 5-mm 30° lens and conventional laparoscopic instruments. The specimens were entrapped in a 10mm endoscopic bag and extracted through the umbilical incision. RESULTS: mean age was 56 years old. Mean BMI was 23.5 [19-34]. Mean operative time was 149min [80-240], and estimated blood loss was 90ml [20-250]. None of the patients required blood transfusion. Mean length of stay was 4.1 days [3-5]. Only one major complication occurred (functional occlusion). One conversion to conventional laparoscopy was necessary in a case of inflammatory kidney. Histologic exam showed benign lesions (cyst and non functional kidney) in seven cases, and papillary carcinoma in three cases. CONCLUSION: LESS surgery is feasible. Its advantages over conventional laparoscopy are not clear. LESS is a new procedure that should benefit from the improvement of technical instrumentation.

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