Objective: To evaluate one institution’s multi-departmental experience performing LESS procedures.
Introduction: LESS, also known as single incision laparoscopic surgery, has emerged as one of the newest surgical modifications of laparoscopic surgery. LESS procedures can be performed using various combinations of articulating and straight instruments with various angled or flexible cameras while achieving similar results to standard laparoscopic surgery in terms of surgical outcomes. LESS procedures can be more costly but the increased costs may be off-set by the improved cosmetic outcome and possibly less postoperative pain.
Methods and Procedures: A retrospective study from North Shore Long Island Jewish Health System evaluating operative times, estimated blood loss and complications from LESS procedures in the general surgery, bariatric surgery, gynecology and urology departments was performed. LESS was performed in 207 cases throughout the respective departments at one institution over a period of 1.5 years by multiple surgeons.
Results: A total of 207 cases were performed successfully with no mortalities or major morbidities. Institutionally there were five (N=10) complications or 4.8% that included: 1 anastamotic leak in a radical prostatectomy (1 out of 1), 2 (2%) biliary leaks after cholecystectomy (2 out of 85), 1 (8%) port replacement in a laparoscopic gastric band (1 out of 12), and were five (N=5) or 2% wound infections. 3 were bacterial and 2 represented Candida overgrowth. Operative times were comparable to standard laparoscopy. There were six (N=6) or 3% cases that required the placement of additional ports. All of the laparoscopic gastric band patients had one 3mm subxiphoid port placed for liver retraction. No cases were converted to open for completion. To date no patients have developed an incisional hernia.
Conclusion: LESS has become a popular and integrated part of General Surgery, Gynecology, and Urology. LESS can be scarless and are the closest procedures to incisionless or Natural Orifice Transluminal Endoscopic surgery (NOTES). In our experience, LESS can be performed safely and effectively without major complication or mortality. We believe there is a patient population who will benefit from and appreciate this near scarless technology. LESS procedures should be more easily accomplished as we improve upon technology of access, instrumentation, organ retraction and cameras. We believe LESS will continue to be a part of General Surgery, Gynecology and Urology and surgeon adoption should increase as the technology with these procedures improves.
Program Number: P552