First Italian experience in single-incision laparoscopic nephrectomy

We describe our laparoscopic nephrectomy technique of placing trocars directly on the fascia once the skin and the subcutaneous layers are prepared. A series of 10 consecutive patients were operated on by single-incision laparoscopic nephrectomy (SILN). With a 5-cm mean skin incision, the fascia was prepared and 3/4 trocars inserted separately directly on the fascia. Surgical strategy followed the standard technique, except for the use of articulating instruments and 5-mm optic. Demographics, body mass index (BMI), operative time, blood loss, perioperative complications, transfusions, hemoglobin decrease, analgesic requirement, length of stay, and final pathology were recorded. Postoperative and prior-to-discharge visual analogue scale (VAS) pain evaluations were also collected, together with the limitations inherent in the instruments' placement and parallel driving during the procedure. The procedures were successfully completed in all but one case. The mean operative time was 169 min. (mean blood loss 113 ml). Without major perioperative complications, the patients were discharged early (mean 5.3 days). Four patients had a BMI>30. For specimen retrieval (neoplasms) two trocar holes were joined. One patient required analgesics; the mean post-operative and prior-to-discharge VAS scores were 5.7 and 1.4, respectively. Pathology examination confirmed 4 pyelonephritic kidneys, 4 renal carcinomas, and 2 upper-urinary tract carcinomas. The laparoscopic nephrectomy via a single incision is feasible and safe, with favorable perioperative and short-term outcomes. It's technically more challenging than standard laparoscopy requiring advanced surgical skills.