Laparoendoscopic Single-Site Radical Nephrectomy for Large Renal Masses

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 (>T-2). 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 T-2, 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.