The additional consumables used in our LESS procedures are l

The additional consumables used in our LESS procedures are listed in Table 2. Additional expenses, other than those for conventional laparoscopy, in this study were US$78 on LESS adrenalectomy, US$224 on LESS nephrectomy, US$254 on LESS nephroureterectomy, US$78 on LESS nephropexy, US$78 on LESS lumbar sympathectomy, and US$78 on LESS hernia mesh repair.
Discussion The recently developed, novel, revolutionary surgical technique, collectively known as LESS, has been successfully used in a wide variety of urological procedures. However, except for cosmetics, the outcome advantages of LESS over conventional laparoscopic procedures, have not been confirmed to date. Most of the enthusiastic acts for the LESS procedure, were virtually driven by the industry marketing of commercial LESS devices. For the unproven benefit of LESS, which increases the cost of health care, the added expenses of these commercial LESS devices should be cautiously managed. In addition, none of the devices are covered by medical insurance, or available in Taiwan. Hence, we conducted a study exploring the feasibility and safety of conventional laparoscopic instruments and homemade single-ports in common urological LESS procedures. To the best of our knowledge, this is the largest published series to date evaluating the safety and effectiveness of conventional laparoscopic instruments in LESS. In our series, the operation was successfully completed in the majority of cases (98%) with a homemade single port and conventional instruments, except for two cases that required laparoscopic conversion. In only one case was the conversion directly related to the inadequate length of conventional laparoscopic instruments. The LESS procedure accounted for more than 60% of our laparoscopic procedures in the same order RVX-208 of time for similar indications and actually non-selected patients for most indications (Fig. 1). None of the patients had a major complication. The minor complications resolved spontaneously and were not directly related to the LESS devices or techniques. The operating time was longer than in conventional laparoscopic surgery in the literature, but the increased time might be related to the time that was consumed in homemade single port creation. Thus, on the basis of our 100 cases, we believe that conventional laparoscopic instruments can be safely and effectively used in LESS for most common urological indications. Several obstacles should be overcome before starting the LESS procedure. The first is creating a multiple access platform that allows comparable universal adoption of conventional laparoscopic ports through a single skin incision, without compromising pneumoperitoneum. Several types of ports are currently commercially available: the TriPort (Advanced Surgical Concepts, Bray, Ireland), Uni-X (Pnavel systems, Cleveland, OH, USA), and the SILS port (Covidien, Cincinnati, OH, USA). However, these commercialized single ports are not yet available in Taiwan. Therefore, we created our own homemade single port with surgical gloves and standard laparoscopic trocars. Our homemade single port has the following merits: (1) it is more cost-effective than commercial single ports and fully covered by medical insurance in Taiwan; (2) it is highly flexible since it is formed by gloves and highly flexible in choice of trocar sizes and arrangements; (3) by using the larger trocar (10- or 12-mm), the biopsy specimen, mesh or needle can be delivered inside/outside the surgical field with ease; and (4) as the double-layered glove is used to build the port, the ballooning effect common in the glove-made single port can be minimized. In addition, the double-layered design prevents air leak, thus making it durable even after punctures by needles or long procedures lasting up to 6 hours. The only possible drawback of the current homemade port, is that its setup is time-consuming, and usually leads to a longer operative time (mean 19.7 minutes longer in this study).