Laparoscopic surgery has dramatically changed the landscape of operative urology, becoming the approach of first choice amongst surgeons and their patients, for its validated benefits of shorter hospitalization, less postoperative pain and earlier recovery. Recently there has been immense interest in both laparo-endoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) approaches to minimally invasive urological surgery. Since Rane etal. [1,2] and Raman etal. [3] performed the world's first human LESS nephrectomies in 2007, there have been several presentations and reports validating the feasibility and reproducibility of LESS procedures in urology, most notably led by investigators from the Cleveland Clinic [4], From these early experiences, it would appear that most extirpative and reconstructive urological procedures performed through conventional multiport laparoscopy can be reproduced via a LESS approach. The single undisputed benefit of LESS is improved cosmesis, constraining trocars or the single-access port to the peri-umbilical site. Whilst Gill etal. [5] reported less postoperative pain and discomfort in patients undergoing donor nephrectomy via the single-port laparoscopic approach, Raman etal. [6] found no significant difference between single-port and conventional multiport laparoscopic nephrectomy in terms of operative time, mean blood loss, hospital stay or postoperative analgesic requirements.
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