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TECHNIQUES AND OUTCOMES OF UROLOGIC LAPAROENDOSCOPIC SINGLE-SITE SURGERY (LESS): WORLDWIDE MULTI-INSTITUTIONAL ANALYSIS

TECHNIQUES AND OUTCOMES OF UROLOGIC LAPAROENDOSCOPIC SINGLE-SITE SURGERY (LESS): WORLDWIDE MULTI-INSTITUTIONAL ANALYSIS OF 1076 CASES. Jihad H. Kaouk, Riccardo Autorino, Michael A. White, Georges-Pascal Haber, Robert J. Stein,

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TECHNIQUES AND OUTCOMES OF UROLOGIC LAPAROENDOSCOPIC SINGLE-SITE SURGERY (LESS): WORLDWIDE MULTI-INSTITUTIONAL ANALYSIS

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  1. TECHNIQUES AND OUTCOMES OF UROLOGIC LAPAROENDOSCOPIC SINGLE-SITE SURGERY (LESS): WORLDWIDE MULTI-INSTITUTIONAL ANALYSIS OF 1076 CASES

  2. Jihad H. Kaouk,Riccardo Autorino, Michael A. White, Georges-Pascal Haber, Robert J. Stein, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA Koon Ho Rha, Jae Won Lee, Woong Kyu Han Dept of Urology, Yonsei University College of Medicine, Seoul, South Korea Deok Hyun Han, Byong Chang Jeong Dept of Urology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea Sun Yinghao, Wang Linhui Dept of Urology, Changhai Hospital, Shanghai, China Sara Best, Jeff Cadeddu Dept of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA Itaar Derweesh, Sean Stroup Division of Urology, Moores UCSD Cancer Center, La Jolla, CA, USA Lee Richstone, Soroush Rais-Bahrami Smith Institute for Urology, NSLIJHS, New Hyde Park, NY, USA Luca Cindolo, Luigi Schips Urology Unit, S. Pio da Pietralcina Hospital, Vasto, Italy Francesco Greco, Paolo Fornara Dept of Urology & Kidney Transplant, Martin-Luther-University, Halle/Saale, Germany Mohamad Allaf, Phillip Pierorazio James B. Brady Urological Institute, Johns Hopkins Institutions, Baltimore, MD, USA Anibal Branco Dept of Urology, Cruz Vermelha Hospital and Vita Batel Hospital, Curitiba, Parana, Brazil Fernando J. Kim Denver Health Medical Center, University of Colorado, Denver, CO, USA Wesley M. White Urology Cancer Center, University of Tennessee Medical Center, Knoxville, TN, USA Abhay Rane Dept of Urology, East Surrey Hospital, Redhill, Surrey, UK René Sotelo, Camilo A. G. Cuevas Unidad de Urología, Instituto Médico La Floresta, Venezuela Evangelos Liatsikos Department of Urology, University of Patras, School of Medicine, Patras, Greece Jens-Uwe Stolzenburg Dept of Urology, University of Leipzig, Leipzig, Germany Participating Investigators & Institutions

  3. LESS UROLOGICAL SURGERY: MULTI-INSTITUTIONAL EXPERIENCE

  4. Objectives • Aim: to provide an analytical overview on indications, techniques and surgical outcomes of urologic LESS in a variable hospital setting worldwide. Collaborative effort of investigators from different Countries Reflects a real life scenario at major Institutions who have pioneered the development of LESS in urology.

  5. Study design • Patients treated with LESS between August 2007 and December 2010 • 18 participating institutions: • 14 university/teaching hospitals • 2 urban public hospitals • 2 private ones. • Data retrospectively collected and gathered into a standardized datasheet

  6. Outcomes analysis • Demographic data: age, gender, race, BMI, past history of previous abdominal/pelvic surgery, ASA score, co-morbidities (hypertension, diabetes, renal insufficiency), clinical indication for LESS procedure. • Procedures categorized as • “extirpative/ablative” or “reconstructive” • “upper urinary tract” or “pelvic” • on a Likert-type scale from 1 (slightly difficult) to 5 (extremely difficult) • Outcome parameters: OR time, EBL, intraop. adverse events, transfusions, length of stay, VAPS. • Relevant operative data related to the surgical procedure: • access technique (single-port or single-incision/single-site) • access site (umbilical or extra-umbilical) • approach (transperitoneal or retroperitoneal) • use of articulating/prebent laparoscopic instruments • use of the da Vinci robotic operating platform (Intuitive Surgical, Sunnyvale, CA) • type of single-port device • use of ancillary 2 or 3 mm needlescopic/minilaparoscopic ports. • Conversions • to reduced port laparoscopy: addition of one extra trocar considered as conversion • to laparoscopic surgery: unplanned installation of >1 trocar to complete the procedure • to open surgery: unplanned abdominal incision to perform the operation. • Postoperative complications scored according to Clavien-Dindo classification system.

  7. Conclusions • The current analysis represents the largest multi-institutional experience with LESS urologic surgery to date. • It provides a real life practice picture of what has been done so fare in this field worldwide. • LESS in urology has significantly evolved in the last 3 years, becoming a widely applicable technique in a short time compared to conventional laparoscopic surgery. • Outcomes demonstrate that a broad range of urologic procedures can be effectively and safely done by applying different LESS techniques in variable hospital settings. • Undeniably, the use of specific instrumentation available for LESS and a solid laparoscopic surgical background is critical for a successful LESS. • Complications are unlikely if stringent patient selection criteria are applied. • Application of robotic technology may further facilitate LESS.

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