Prof. Luigi SchipsDept of Urology – “S.Pio da

Pietrelcina” HospitalVasto - Italy

Single port nephrectomy:

is it worth it? PROPRO

The traces of our experience

PubMed search: single port and….

Agenda

Chronological aspects

Indications and approaches

Results

Perspectives

Agenda

Chronological aspects

Indications and approaches

Results

Perspectives

The first

… but a first experience in children was described in the 2006

Today, a growing and ongoing experience

Great interest from Companies, patients and surgeons

Agenda

Chronological aspects

Indications and approaches

Results

Perspectives

The most exploredSimple nephrectomyPartial nephrectomy ± ischemiaRadical nephrectomyCitoreductive nephrectomyNephroureterectomyNephrectomy in childrenPelvic kidney nephrectomyLiving donor nephrectomyRenal crioablation Renal biopsy

Transperitoneal

Retroperitoneal

Robotic

NOTES-hybrid

Different trocars

The most commonly performed

2009 Desai , 42 pts2009 White,74 pts

2009 Stolzenburg, 10 pts2009 Ryu, 5 pts2010 Lee, 4 pts

2010 Canes 18 (donor)2010 Raybourn, 11 pts

2010 Jeong, 21 pts2011 Choi,123 pts2011 Seo, 11 pts

2011 Kurien, 24 pts (donor) 2011 Schips, 25 pts

Agenda

Chronological aspects

Indications and approaches

Results

Perspectives

Surgical outcomes

Operative time

Blood loss

Complication rate

Conversion to open

No differences

Better in LESS group

No differences

Better in LESS group

Raman 2009, Andonian 2010, Tugcu 2010, Park 2010, Raybourn 2010, Seo 2011, Kurien 2011

Surgical outcomes

Hospital stay

Transfusion rate

Postop. pain

Cosmesis

No differences

Better in LESS group

Better in LESS group

Better in LESS group

Raman 2009, Andonian 2010, Tugcu 2010, Park 2010, Raybourn 2010, Seo 2011, Kurien 2011

Agenda

Chronological aspects

Indications and approaches

Results

Perspectives

How to have robust evidence in surgical innovation: RCT?

Research on surgery is associated with several methodological and practical challenges

Large, high-quality RCTs have been done in a variety of surgical specialties, but those of the surgical procedure itself are uncommon

It is difficult to decide when to shift from an early exploratory stage of development to a formal investigation. If too early, the constraints of an RCT could obstruct innovation, and if too late, equipoise could be lost.

The IDEAL paradigm

A journey of one thousand miles begins with a single step.

Lao-Tzu

Future perspectives

History of LESS started only 3 yr ago

We arguably are still completing our learning curve

The potential benefit for LESS goes much further than cosmesis

Not cosmesis but less morbidity to our patients!

Urologists = pioneers of experimental and clinical

development of LESS

Urologists = translators of new skills and

knowledge into a clinical benefit for patients

It is not all about the scar

Future perspectives

Databases

Registries

Complications

Robotic LESS

VisibilityCompanies Interests