LESS : Rationale And Evolution
Lord Moynihan of Leeds <ul><li>‘ Big surgeons make big incisions’  </li></ul>
Progression of MIS <ul><li>‘ Open’ surgery with smaller incisions </li></ul><ul><li>‘ Mini’ lap </li></ul><ul><li>Hand ass...
Surgical Revolution <ul><li>All specialties – minimally invasive revolution </li></ul><ul><li>Laparoscopy = significant pa...
Publications <ul><li>Peer reviewed literature </li></ul><ul><ul><li>Single Incision Laparoscopic Surgery (SILS) </li></ul>...
Terms used to date  <ul><li>Single Incision Laparoscopic Surgery (SILS™)  </li></ul><ul><li>Single Site Laparoscopy (SSL™)...
Keyword queries from MEDLINE and  www.pubmed.gov  (accessed 20 Nov, 2008) <ul><li>Keyword Number of citations Urological  ...
Is this LESS?
Or is this LESS?
9 July 2008, Cleveland Clinic <ul><li>Multi-disciplinary consortium of experts: general surgeons, gynaecologists, urologis...
LESS  <ul><li>Laparo-Endoscopic Single-site Surgery’  (LESS)  was both scientifically accurate and colloquially appropriat...
LESS
Pioneers in Urological LESS
PubMed, accessed 10 May, 2009 <ul><li>LESS: 24397 hits </li></ul><ul><li>Laparo Endoscopic Single Site Surgery: </li></ul>...
PubMed, accessed 23 January 2010 <ul><li>LESS: 975262 hits </li></ul><ul><li>Laparo Endoscopic Single Site Surgery: </li><...
 
 
5 May 2007: 1 st  LESS nephrectomy
 
 
 
 
 
 
 
Barret et al, J Endourol ,2009
 
 
 
 
 
100 patient series
Thank you, gracias, obrigado,  谢谢  <ul><li>Acknowledgements: </li></ul><ul><li>Lee Richstone, Lee Ponsky </li></ul><ul><li...
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LESS : Rationale And Evolution

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LESS : Rationale And Evolution

LESS : Rationale And Evolution

  1. 1. LESS : Rationale And Evolution
  2. 2. Lord Moynihan of Leeds <ul><li>‘ Big surgeons make big incisions’ </li></ul>
  3. 3. Progression of MIS <ul><li>‘ Open’ surgery with smaller incisions </li></ul><ul><li>‘ Mini’ lap </li></ul><ul><li>Hand assisted laparoscopy </li></ul><ul><li>Multiport laparoscopy (inc robotics) </li></ul><ul><li>LESS </li></ul><ul><li>NOTES </li></ul>
  4. 4. Surgical Revolution <ul><li>All specialties – minimally invasive revolution </li></ul><ul><li>Laparoscopy = significant patient benefits: </li></ul><ul><li> Pain </li></ul><ul><li> Hospitalization </li></ul><ul><li> Recovery </li></ul><ul><li> Complications </li></ul><ul><li> Scars </li></ul><ul><li> Cost </li></ul>
  5. 5. Publications <ul><li>Peer reviewed literature </li></ul><ul><ul><li>Single Incision Laparoscopic Surgery (SILS) </li></ul></ul><ul><ul><li>Single Port Access (SPA) </li></ul></ul><ul><ul><li>One Port Umbilical Surgery (OPUS) 1 </li></ul></ul><ul><ul><li>Natural Orifice Trans Umbilical Surgery (NOTUS) 2 </li></ul></ul><ul><ul><li>Trans Umbilical Endoscopic Surgery (TUES) 3 </li></ul></ul><ul><ul><li>Trans Umbilical Laparoscopic Assisted (TULAA) 4 </li></ul></ul><ul><ul><li>Embryonic orifice - NOTES (e-NOTES) 5 </li></ul></ul><ul><li>1. Rane et al Single-Port-Access Nephrectomy and Other Laparoscopic Urologic Procedures Using a Novel Laparoscopic Port Urology. 2008 Aug;72(2):260- </li></ul><ul><li>Cuesta MA et al The &quot;invisible cholecystectomy&quot;: A transumbilical laparoscopic operation without a scar. Surg Endosc 2007 </li></ul><ul><li>Zhu JF. Scarless endoscopic surgery: NOTES or TUES. Surg Endosc 2007; 21:1898-1899. </li></ul><ul><li>4. Pappalepore et al Transumbilical laparoscopic-assisted appendectomy (TULAA): a safe and useful alternative for uncomplicated appendicitis. Eur J Pediatr Surg 2002; 12:383-386 </li></ul><ul><li>5. Gill I et al Single Port Transumbilical (E-NOTES) Donor Nephrectomy, J Urol 2008, Vol. 180, 637 </li></ul>
  6. 6. Terms used to date <ul><li>Single Incision Laparoscopic Surgery (SILS™) </li></ul><ul><li>Single Site Laparoscopy (SSL™) </li></ul><ul><li>Single Portal Laparoscopy (S-PORTAL™) </li></ul><ul><li>Single Port Access (SPA™) </li></ul><ul><li>Single Port Laparoscopy (SPL) </li></ul><ul><li>Single Site Access (SSA) </li></ul><ul><li>One Port Umbilical Surgery (OPUS) </li></ul><ul><li>Visibly Scarless Urologic Surgery ( VSUS) </li></ul><ul><li>SLiPP (Single Laparoscopic Port Procedure) </li></ul><ul><li>Natural Orifice Trans Umbilical Surgery (NOTUS) </li></ul><ul><li>Trans Umbilical Endoscopic Surgery (TUES) </li></ul><ul><li>Trans Umbilical Laparoscopic Assisted (TULA) </li></ul><ul><li>Embryonic Natural Orifice Transluminal Endoscopic Surgery (E-NOTES) </li></ul><ul><li>Single Laparoscopic Incision Transabdominal (SLIT) </li></ul><ul><li>(Laparo-Endoscopic Single Site Surgery) LESS </li></ul>
  7. 7. Keyword queries from MEDLINE and www.pubmed.gov (accessed 20 Nov, 2008) <ul><li>Keyword Number of citations Urological citations </li></ul><ul><li>Single port access 131 16 </li></ul><ul><li>Single port access surgery 96 11 </li></ul><ul><li>Combined single port access 11 1 </li></ul><ul><li>Robot assisted single port surgery 8 6 </li></ul><ul><li>Single incision laparoscopic surgery 181 43 </li></ul><ul><li>Single port laparoscopy 162 32 </li></ul><ul><li>Single port laparoscopic surgery 181 39 </li></ul><ul><li>Single incision laparoscopy 142 28 </li></ul><ul><li>One port umbilical surgery 103 14 </li></ul><ul><li>Visibly scarless surgery 8 0 </li></ul><ul><li>Single keyhole umbilical surgery 1 1 </li></ul><ul><li>Single trocar laparoscopic surgery 230 42 </li></ul><ul><li>Single trocar transumbilical surgery 7 5 </li></ul><ul><li>Scarless single port transumbilical surgery 2 1 </li></ul><ul><li>Single access site laparoscopic surgery 18 5 </li></ul>
  8. 8. Is this LESS?
  9. 9. Or is this LESS?
  10. 10. 9 July 2008, Cleveland Clinic <ul><li>Multi-disciplinary consortium of experts: general surgeons, gynaecologists, urologists </li></ul><ul><li>Brainstorming to determine a universally acceptable name for single incision surgery </li></ul>
  11. 11. LESS <ul><li>Laparo-Endoscopic Single-site Surgery’ (LESS) was both scientifically accurate and colloquially appropriate </li></ul><ul><li>LESSCAR: Laparo-Endoscopic Single-site Surgery Consortium for Assessment and Research </li></ul><ul><li>Term ratified by NOTES working group of the Endourological Society </li></ul><ul><li>Will be adapted as future standard for reference: multispecialty </li></ul><ul><li>Transumbilical access: U-LESS </li></ul>
  12. 12. LESS
  13. 13. Pioneers in Urological LESS
  14. 14. PubMed, accessed 10 May, 2009 <ul><li>LESS: 24397 hits </li></ul><ul><li>Laparo Endoscopic Single Site Surgery: </li></ul><ul><ul><li>15 citations </li></ul></ul><ul><ul><li>13 urology </li></ul></ul><ul><ul><li>2 general surgery </li></ul></ul>
  15. 15. PubMed, accessed 23 January 2010 <ul><li>LESS: 975262 hits </li></ul><ul><li>Laparo Endoscopic Single Site Surgery: </li></ul><ul><ul><li>52 citations (5 review) </li></ul></ul><ul><ul><li>32 urology </li></ul></ul><ul><li>SAGES 2010: 55% of world literature is urological </li></ul>
  16. 18. 5 May 2007: 1 st LESS nephrectomy
  17. 26. Barret et al, J Endourol ,2009
  18. 32. 100 patient series
  19. 33. Thank you, gracias, obrigado, 谢谢 <ul><li>Acknowledgements: </li></ul><ul><li>Lee Richstone, Lee Ponsky </li></ul><ul><li>Rene Sotelo </li></ul><ul><li>Jeff Cadeddu </li></ul><ul><li>Jihad Kaouk </li></ul><ul><li>Mahesh Desai </li></ul><ul><li>Pradeep and Prashanth Rao </li></ul><ul><li>Indy Gill, Monish Aron and Mihir Desai </li></ul>

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