Retroperitoneal Laparoendoscopic Single-Site Simple Nephrectomy: Initial Experience

Purpose: To present our early experience with retroperitoneal laparoendoscopic single-site (LESS) simple nephrectomy. Patients and Methods: A total of 16 patients with benign nonfunctioning kidney underwent retroperitoneal LESS nephrectomy by one experienced laparoscopic surgeon. A single-port access was inserted through an approximately 3-cm lumbar incision made below the 12th rib along the midaxillary line. Standard steps of multisite retroperitoneoscopic nephrectomy technique with a combination of conventional and bent laparoscopic instruments were performed. Results: Retroperitoneal LESS nephrectomy was performed in 15 cases successfully. The procedure of one patient (genitourinary tuberculosis) needed conversion to open surgery because of the severe adhesions surrounding the kidney, which resulted in failure to progress. Overall, the mean operative time was 85 (75-140) minutes, and estimated blood loss was 56 (20-110) mL. The mean time to resume oral diet was 1.5 days. The mean postoperative hospital stay was 4 (3-5) days. Perioperative complications were limited to one case of transient postoperative fever. No major intraoperative and postoperative complication occurred. Conclusions: Retroperitoneal LESS nephrectomy performed by an experienced laparoscopic surgeon is feasible and safe, offering improved cosmesis, although it remains technically challenging. Retroperitoneal LESS nephrectomy should be selectively used in terms of patients' specific conditions.