Autorino Riccardo, Kim Fernando J
Urology Clinic, Second University of Naples, Naples, Italy.
Urologia. 2011 Jan-Mar;78(1):32-41. doi: 10.5301/ru.2011.6448.
The evolution of minimally invasive surgery led to the development of laparo-endoscopic single-site surgery (LESS).
The feasibility of almost all types of urologic procedures has been shown. Comparative series between conventional laparoscopy and LESS for different kidney procedures suggest a non-inferiority of LESS over standard laparoscopy but the only objective benefit remains an improved cosmetic outcome. Challenging ergonomics, instruments clashing, lacks of true triangulation, in-line vision are the main concerns of LESS surgery. LESS pre-bent and articulating instruments have been designed but only experienced laparoscopists and well-selected patients are pivotal for a successful LESS procedure. Da Vinci® assisted LESS procedures have been performed. The available robotic platform remains bulky, but innovative instruments and platforms may facilitate the future unrestricted development of LESS.
A steep learning curve limits the application of LESS procedures to well trained and experienced surgeons. Nevertheless, the adoption of LESS principles and the clinical experience with LESS techniques have significantly grown in the past few years worldwide. Improvements in the instruments and platforms will expand the application of LESS surgery, allowing us to better assess its advantages and disadvantages compared to other minimally invasive procedures.
微创手术的发展促使了腹腔镜单切口手术（LESS）的出现。
几乎所有类型的泌尿外科手术都已证明其可行性。针对不同肾脏手术的传统腹腔镜手术与LESS的比较系列研究表明，LESS并不逊色于标准腹腔镜手术，但唯一客观的益处仍是改善了美容效果。LESS手术面临的主要问题包括人体工程学挑战、器械碰撞、缺乏真正的三角定位以及直线视野。已设计出LESS预弯和可弯曲器械，但只有经验丰富的腹腔镜手术医生和精心挑选的患者对于LESS手术的成功至关重要。已开展了达芬奇®辅助LESS手术。现有的机器人平台仍然庞大，但创新器械和平台可能会促进LESS未来的无限制发展。
陡峭的学习曲线限制了LESS手术仅适用于训练有素且经验丰富的外科医生。尽管如此，在过去几年中，LESS原则的采用和LESS技术的临床经验在全球范围内显著增加。器械和平台的改进将扩大LESS手术的应用范围，使我们能够更好地评估其与其他微创手术相比的优缺点。
