SINGLE-INCISION LAPAROSCOPIC SURGERY (SILS) FOR UROLOGIC DISEASES: THE FIRST EXPERIENCE AT A HIGH-VOLUME LAPAROSCOPIC CENTRE

Aim the study: The SILS represent an evolution of laparoscopy in the treatment of urologic diseases but few studies concerning its safety and feasibility are still avaible. Material and methods: Since May 2009 38 patients underwent a SILS operation in for different urologic diseases. Thirty-five operations were performed in the Martin-Luther- University and 3 in the S. Chiara di Trento hospital. The indications to perform a SILS were represented by: renal cysts, functionlos kidneys, symptomatic varicocele, nephropexy, renal tumors, lymphocele. Demographic data and perioperative and postoperative measurements and outcomes were prospectively recorded in a database and analysed. Results: The mean age of the patients was 50,5±26,5 years old and the mean BMI was 27.5 ± 6 kg/m2. The study included 22 women and 16 men. The mean operating time was 122,5±72,5 min and the mean blood loss was 122.30±34.19 ml. Of these 38 patients, 28 patients underwent a SILS radical nephrectomy for renal cell carcinoma, one patient underwent a SILSvaricocelectomy, one a nephropexy, 6 a nephrectomy for atrophic kidney, one a lymphocele marsupialitation and 1 a SILS-renal cyst marsupialitation. All SILS-RN were performed successfully without conversion to an open procedure and no major complications occurred in both groups. The mean hospital stay was 3.8±0.8 days and the mean skin incision lenght was 4.1±0.6 cm. Discussion: Minimally invasive surgery aims to provide effective treatment of surgical diseases inside a body cavity, while decreasing access-related morbidity with a reduced postoperative pain, shorter hospital stay, faster recovery, improved cosmesis, and early return to daily occupation. SILS is a single port technique through the umbilicus that has additional benefits, such as a decreased number of trocars, decreased postoperative pain and the cosmetic advantage of hiding the operative scar in the umbilicus. This is mean point which has to be investigated: is the SILS-surgery oncologic safe? If the first studies about SILS are concentrated to report surgical outcomes, we are expecting in the future studies reporting long-term follow-up after SILS in order to evaluate its oncologic feasibility. Conclusion: SILS is a safe and feasible surgical procedure in the treatment of urologic diseases, with excellent cosmetic results. Nevertheless more prospective studies are needed to investigate the oncologic safety of this technique in the therapy of urologic malignant tumors.