Prof. Luigi Schips Dept of Urology – “S.Pio da Pietrelcina” Hospital Vasto - Italy PRO Single port nephrectomy: is it worth it? PRO

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 explored Simple nephrectomy Partial nephrectomy ± ischemia Radical nephrectomy Citoreductive nephrectomy Nephroureterectomy Nephrectomy in children Pelvic kidney nephrectomy Living donor nephrectomy Renal crioablation Renal biopsy Transperitoneal Retroperitoneal Robotic NOTES-hybrid Different trocars

The most commonly performed 2009 Desai, 42 pts 2009 White,74 pts 2009 Stolzenburg, 10 pts 2009 Ryu, 5 pts 2010 Lee, 4 pts 2010 Canes 18 (donor) 2010 Raybourn, 11 pts 2010 Jeong, 21 pts 2011 Choi,123 pts 2011 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 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 Visibility Companies Interests