Is a single-site laparoendoscopic approach a real surgical advancement for the management of small renal masses?

Nephron-sparing surgery (NSS) ensures equivalent oncological results while improving overall survival compared with radical nephrectomy when applied to the treatment of small renal masses, moreover warm ischemia is associated with a risk of acute renal failure and advanced chronic kidney disease (CKD). Laparoendoscopic single-site (LESS) unclamp NSS is the next step forward in the management of small renal masses. From 2009 to 2013 we have treated 23 patients with small renal masses ( < 4 cm) amenable to the LESS approach using unclamp LESS NSS. In 20 cases we were able to complete the operation using LESS, in 3 cases conversion to standard laparoscopy was required. Pathologic examination revealed 16 cases of clear-cell renal cell carcinoma (RCC), 4 cases of renal cysts, 2 oncocytomas, and 1 angiomyolipoma. We did not find any significant variation in renal function or any case of tumor recurrence, and the majority of the patients were very satisfied of the cosmetic results. LESS unclamp partial nephrectomy is a safe and feasible procedure, oncological outcomes are similar to standard laparoscopy, there is an advantage with respect to renal function and cosmesis, although the procedure is more technically demanding compared with standard laparoscopy.