Transumbilical Laparoendoscopic Single-Site Surgery: More Than 1-Year Experience in Radical Nephrectomy and Its Learning Curve Study

Purpose: The aim is to report our 1-year experience in transumbilical Laparoendoscopic single-site (LESS) radical nephrectomy (LESS-RN) and assess its learning curve. Patients and Methods: From September 2009 to December 2010, 18 consecutive patients with a solitary renal tumor underwent transumbilical LESS-RN. We grouped measured parameters on the basis of the first nine (group A) and last nine (group B) patients, and compared both subgroups with the control group (C), which was composed of the initial nine consecutive patients who underwent conventional laparoscopic RNs performed by the same surgeon. Results: There was one LESS patient converted to conventional laparoscopic surgery for intraoperative hemorrhage and transfused. The mean for measured parameters of the groups A, B, C were: age: 58.6, 57.2, and 59.2 years, respectively (P>0.05); American Society of Aneshesiologists score: 1.9, 2.0, and 2.0, respectively (P>0.05); body mass index: 25.2, 23.5, and 23.1 kg/m2, respectively (P>0.05); lesion size at CT scan: 5.0, 4.6, and 6.2 cm, respectively (P=0.039); operative skin to skin time: 191.6, 123.9, and 122.2 minutes, respectively (P=0.000); estimated blood loss: 172.2, 246.7, and 116.7 mL, respectively (P>0.05); incision length: 5.6, 5.9, and 7.4 cm, respectively (P=0.000); hospital stay: 5.8, 5.8, and 5.8 days, respectively (P>0.05). At the latest follow-up, all patients did not present any local recurrence or metastasis. Conclusions: In selected patients, the transumbilical LESS-RN can be safely performed with favorable outcomes. While a learning curve certainly exists, it appears to be short for an experienced laparoscopic surgeon.