Laparoendoscopic single-site surgery: complications and how to avoid them.

Berkowitz, Jared R; Allaf, Mohamad E

INTRODUCTION Laparoendoscopic single-site surgery (LESS) has emerged as a natural progression from standard laparoscopy aiming to further minimize the morbidity of urological procedures. Recent advances in technology and instrumentation coupled with a mastery of laparoscopic surgery by some has led to the incorporation of LESS techniques in a variety of complex urological operations. Given the paucity of published data regarding complications, we review the collective experience as well as share our own results and observations. METHODS A literature search of published series on LESS was performed focusing on complications and other difficulties associated with this new technique. The experience with LESS at our institution was also evaluated for complications and means of avoiding them. RESULTS A few complications relating to LESS specifically are reported in the literature. These are generally related to the access site and the ability to manage situations that require added dexterity. Conversion to standard laparoscopy (or open surgery) is rare while insertion of an additional port appears to be more common. CONCLUSIONS LESS is an evolving platform and may have a steeper learning curve than standard laparoscopy. In experienced hands, the rates of LESS complications appear to be similar to other surgical techniques.