Login to Access Video or Poster Abstract: MP52-04
Sources of Funding: none

Introduction

Laparoendoscopic single-site (LESS) surgery for urologic procedures was initially embraced by many with great enthusiasm. However, it became clear that this was a technique with a steep learning curve biased towards skilled laparoscopic surgeons. The aim of this study was to analyze the most recent temporal trends in the adoption of urologic LESS, to identify the perceived limitations associated with its decline, and to determine factors that might revive the role of LESS.

Methods

A 15 question survey was created using Google Forms and sent to members of the endourological society in September 2016. Out of the 2800 email addresses listed in the database, we asked only members who performed LESS procedures in practice to respond to the survey.

Results

106 urological surgeons responded to the survey. Most of the respondents were from the United States (35%) and worked in an academic hospital (84.9%). Standard LESS was the most popular approach (78.1%), while 14.3% used robotics and 7.6% used both. 2009 marked the most popular year to perform the initial and the majority of LESS procedures, 27.6% and 20%, respectively. The most common LESS procedure was a radical/simple nephrectomy at 51% followed by pyeloplasty at 17.3%. When asked approximately how many LESS procedures have you performed in the past 12 months, 63 (60%) urologists stated none. When asked to compare LESS to conventional laparoscopy, only cosmesis was deemed to be better. Over time, opinions changed about cosmesis such that an increase in 82% and a decrease in 26% of surgeons thinking LESS was no different and LESS was better than laparoscopy, respectively. Worsening shifts in enthusiasm for LESS also occurred with patient desire, marketability, cost, safety, and robotic adaptability (Figure 1). Factors rated the highest to help LESS gain popularity included a new robotic platform (4.25/5), instrument modifications (4.03/5), and improved suturing (3.97/5).

Conclusions

2009 represented the peak year for implementation of LESS in urology. Several factors have contributed to the decline of the technique over the past 5 years. The availability of a purpose-built robotic platform and better instrumentation overcoming current ergonomic challenges might translate into a renewed future interest of LESS.

Funding

none