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Ces Urol 2015; 19(1): 83–85
VIDEO
Claviena 3 x 2, 2 x 3b (operační revize pro lézi tenké
kličky zavzaté do stehu minilaparotomie resp. krvá-
cení z jater) a 1 x 4a (pooperační kardiopulmonální
resuscitace).
Závěr:
LESS NE prováděnou zkušeným laparos-
kopistou je relativně bezpečná a efektivní metoda
nefrektomie pro benigní i maligní onemocnění
u vybraných případů (BMI<33 a méně pokročilé
tumory).
KLÍČOVÁ SLOVA
Nefrektomie, laparoskopie.
SUMMARY
Hora M. LESS (laparo-endoscopic single-site sur-
gery) nephrectomy.
Introduction:
The video presents our tech-
nique of LESS nephrectomy.
Material:
From 8/2011 to 10/2014 we per-
formed 262 mini-invasive nephrectomies includ-
ing 62 LESS procedures (23.7%) that are evalu-
ated below. There were 26 men, 36 women, 33
left sided and 29 right sided. The mean BMI was
26.9±3.9 (16–33.2). We used mostly Quadport+®
and GelPoint® in 8 cases. There were 45 tumours
and 17 benign masses. We had no strict indication
criteria for LESS, it depended on subjective evalua-
tion of the feasibility of surgical team. Procedures
were performed by 4 surgeons. Nonobese patients
with less advanced tumours were included.
Method:
This video presents a typical case. The
surgery begins in a flank position using transumbi-
lical minilaparotomy and multichannel port (Quad-
port+®). A 10 mm 0° video camera, one pre-bent
grasper and some sealing devices were used. The
lower pole of the kidney is deliberated, the ureter
and hilum are identified and elevated by using
a thread that is introduced through the abdomi-
nal wall. The renal hilum is divided en bloc with
a stapler. The kidney is totally deliberated without
any drainage.
Results:
We used the transumbilical approach
in 27 LESS (43.5%) nephrectomies (the last 19 only
with this procedure) and a pararectal incision in the
rest. An additional port was used in 27.4% (17) –
2/33 (6.1%) on the left, 15/29 (51.7%) on the right.
In 3 cases of them (4.8%), another additional port
(conventional laparoscopic nephrectomy) was nec-
essary. There were 2 conversions (3.2%). The mean
operation time (OT) was 96.7±40.0 (28–230) min-
utes. The most experienced surgeon had mean
OT 73.4±20.0 (28–104). Hilar vessels were divided
separately in 14 (22.6%) cases using lockable clips,
and 48 (77.4%) cases en bloc with a stapler. The
mean hospitalization time was 5.9±4.8 (2–40) days.
Complications according to the Clavien-Dindo clas-
sificationwere 3 times grade II and 2 times grade IIIb
(revisions for lesion of small intestine sutured to the
minilaparotomy and liver bleeding) and one grade
IVa (postoperative cardiopulmonary resuscitation).
Conclusion:
In selected cases (BMI<33 and less
advanced tumours). LESS nephrectomy performed
by an experienced laparoscopic surgeon, is a safe
and effective method for benign and malignant
kidney masses.
KEY WORDS
Nephrectomy, laparoscopy.
LITERATURA
1. Eret V, Schmidt M, Stránský P, et al.
Laparoendoscopic single-site surgery (LESS) in urology – a new
frontier in minimally invasive surgery? Ces Urol. 2012; 16(3): 146–156.
2. Hora M, Eret V, Stránský P, et al.
Position of laparo-endoscopic single-site surgery nephrectomy in
clinical practice and comparison (matched case-control study) with standard laparoscopic nephrectomy.
Videosurgery and Other Miniinvasive Techniques. 2014; 9(3): 371–379.