Editorial Comment to laparoendoscopic single‐site urological surgery: Initial experience in Japan

Abstract

This paper describes the authors' initial experience with LESS surgery in urology to perform a varicocele repair and pyeloplasty. Although there is no new message in the manuscript, the authors are to be commended for taking up the technique and reporting their early experience. Successful LESS surgery involves the use of articulating or bent instrumentation via a single large-caliber trocar or small, adjacent trocars. Advances in technology have led to the development of new laparoscopic access ports (R-Port and Quadriport, Advanced Surgical Concepts, Wicklow, Ireland; GelPoint, Applied Medical, Rancho Santa Margarita, CA, USA) and the SILS Port (Covidien, Norwalk, CT, USA) capable of permitting several instruments to be inserted through multiple channels incorporated in, and as part of, a larger single port. The AirSeal device (Surgiquest, Palo Alto, CA, USA) has been used to perform a single port cholecystectomy and hysterectomy in humans. The next generation of articulating instrumentation is already being developed and pre-bent dedicated rigid LESS instrumentation will be commercially available soon. Magnetic retraction and guidance systems have been successfully trialed in the human setting.1,2 The next generation of suture aids (EndoStitch, Covidien, Norwalk, CT, USA) will have a roticulating component to allow for easier reconstruction while performing LESS. Robotic techniques have added yet another dimension to the types of complex procedures that might be undertaken using LESS.3,4