Laparoendoscopic Single-Site Radical Nephrectomy for Large Renal Masses

Abstract

Purpose:

To report our operative experience and short-term outcomes for the laparoendoscopic single-site (LESS) management of large renal tumors and tumors of advanced stage.

Patients and Methods:

Ten consecutive patients underwent LESS-radical nephrectomy (RN) for large (≥7 cm) and/or locally advanced tumors (>T₂). Intraoperative, postoperative, and short-term follow-up data were analyzed.

Results:

Median surgical time was 146 minutes (range 73–164 min), and median estimated blood loss was 100 mL (range 25–400 mL). No procedure needed conversion to open RN or hand-assisted laparoscopic RN. The median hospital stay was 47 hours (range 42 hours–12 days). One (10%) patient had a minor complication (postoperative fever treated with antibiotics) and one (10%) patient had a major complication (small bowel obstruction necessitating reoperation). Of the 10 tumors, 2 were pathologic stage T_1b, 4 were pathologic stage T₂, and 4 were stage T_3a. At a median follow-up of 12.3 months (range 1–16 mos), six (60%) patients were alive without evidence of recurrence, and 4 (40%) patients were alive with disease. Of those four patients, all four had known metastatic disease before surgery.

Conclusion:

LESS-RN for large or advanced stage renal masses is a technically challenging operation. In experienced hands, however, it is a safe and feasible therapeutic option for the management of these tumors.