Laparoendoscopic single-site surgery (LESS) for the treatment of different urologic pathologies in pediatrics: Single-center single-surgeon experience

Summary Introduction Recently LESS has been reported as a valid minimally option for treatment of some urologic pathologies in pediatrics. However, the initial reports of pediatric LESS are still limited to case reports and initial case series. This may be due to the inherent technical difficulty of LESS and the currently available LESS instruments. In this report, we present the largest case series of pediatric LESS for treatment of different urologic pathologies in pediatrics. Materials and methods Included in this study are children who had LESS during the period of January 2011 to June 2013. Both Olympus TriPort (Olympus, New York, USA and Advance Surgical Concept, Wicklow, Ireland) and Covedien SILS access port (Covedien, Chicopec, Massachusetts, USA) were used and were inserted through the umbilicus. Exclusion criteria included children less than 3 years old, history of previous transperitoneal abdominal surgery, malignant indications, and complex urogenital congenital anomalies. All LESS procedures were done by a single experienced laparoscopist and data were reviewed retrospectively. Results Twenty-two children had 39 LESS procedures without conversion to conventional laparoscopy or open surgery. No intraoperative or postoperative complications were reported and no extra-port was added in any of the patients. The following table shows the mean age, operative time, hospital stay, VAS as well as the overall mean of different LESS procedures. Diagnosis Age (years) OR time (minutes) Blood loss (ml) Hospital stay (days) VAS UDT ( n = 13) 4.9 ± 1 45.2 ± 3.9 15.0 ± 5.0 0.0 0.4 ± 0.1 Varicocele ( n = 4) 15.2 ± 0.5 41.3 ± 6.2 5.5 ± 1.6 0.0 0.4 ± 0.1 Nephrectomy ( n = 2) 10.0 ± 0.5 125.0 ± 5.0 70.0 ± 15.2 1.2 ± 0.21 1.5 ± 0.3 UPJO ( n = 3) 14.2 ± 2.6 155.6 ± 5.6 45.5 ± 6.9 2.0 ± 0.0 1.2 ± 0.6 Total ( n = 22) 6.3 ± 4.2 89.6 ± 22.8 32.2 ± 22.1 0.5 ± 0.3 0.5 ± 0.3 UDT = undescended testis, UPJO = ureteropelvic junction obstruction, OR = operative, VAS = visual analogue pain scale. In all patients the umbilical scar was invisible and all patients and their parents had high wound satisfaction. At a mean follow up of 18.6 ± 6.4 months, all patients with UPJO had successful repair. Discussion Our study included 13 boys with undescended testis who were managed in different ways according to the length of spermatic vessels and the size of the testis. One of the arguments against LESS management of undescended testis is that it requires a 2.5-cm incision, which is col