Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laparoendoscopic single-site surgery (LESS) can provide cosmetic advantages to patients. However, LESS pyeloplasty and other reconstructive procedures pose substantial technical challenges compared to traditional laparoscopy. The impact these challenges have on the learning curves of these operations is incompletely understood. This investigation reviews the initial experience of an experienced laparoscopist over the first 28 cases of LESS pyeloplasty he performed, providing insight into the learning curve as reflected by changes in operative time and post-operative complications over time. OBJECTIVE • To review our initial series of laparoendoscopic single-site (LESS) pyeloplasties, focusing on 30-day complication rates as an indicator of learning curve, and to define the expected morbidity. PATIENTS AND METHODS • The study comprised 28 patients who underwent LESS pyeloplasty by a single surgeon from October 2007. • A chart review was undertaken to identify the complications that occurred within the first 30 days after surgery. RESULTS • The mean operating time was 197 min. • Seven patients (25%) experienced a total of eight complications. Four patients required nephrostomy tube placement (14%) during the early postoperative period, two for symptomatic obstruction despite the ureteral stent and two for a urine leak. Another had urine leakage that resolved spontaneously after she went home with the surgical drain for 1 week. One patient (4%) developed a retroperitoneal haematoma and required blood transfusion and one had haematuria that prolonged hospital stay by 2 days. • Of the patients experiencing complications, 71% were in the first ten cases. Only two complications occurred in the subsequent 18 patients. CONCLUSIONS • The LESS pyeloplasty procedure is a technically difficult, even for an experienced laparoscopic surgeon and the surgical challenges of this technique may translate to a higher complication rate for LESS than for conventional laparoscopic pyeloplasty early in the learning curve. However, within a relatively few cases, the complication rate is similar to that of standard laparoscopic pyeloplasty. • Additional follow-up is required to determine the long-term success rate.
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