Indian Journal of Urology Users online:806  
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size

  Table of Contents 
Year : 2012  |  Volume : 28  |  Issue : 1  |  Page : 1-2

Is LESS is actually more?

Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication12-Apr-2012

Correspondence Address:
Nitin S Kekre
Department of Urology, Christian Medical College, Vellore, Tamil Nadu
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-1591.94937

Rights and Permissions


How to cite this article:
Kekre NS. Is LESS is actually more?. Indian J Urol 2012;28:1-2

How to cite this URL:
Kekre NS. Is LESS is actually more?. Indian J Urol [serial online] 2012 [cited 2023 Jan 27];28:1-2. Available from:

Surgeons since long have long attempted to make surgery less invasive. While the advantages of less morbidity and improved cosmesis are obvious, it has made the procedure more technically challenging with a steeper learning curve. The advent of laparoendoscopic single-site surgery (LESS), technically, perhaps an extension of conventional laparoscopic surgery, is a case in point.

The idea itself is not new. In the early 1970s, Wheeless, a gynacologist described more than 4000 cases of single-port laparoscopic tubal ligation. [1] This technique was to become the standard of care for tubal ligation in later years. Two decades later Inoue reported a technique of single-port laparoscopic appendectomy. [2]

With more centers attempting this procedure and the lack of a standard nomenclature became obvious. A veritable "battle of acronyms" started with SILS (single-incision laparoscopic surgery), MISPORT (minimally invasive single-port surgery), SPES (single-port endoscopic surgery), OPUS (one-port umbilical surgery), SPL (single-port laparoscopy), UNOTES (umbilical natural orifice transluminal endoscopic surgery), and STLS (single-trocar laparoscopic surgery) describing the same procedure. [3]

The lack of standardization prompted the NOTES Working Group of the Endourological Society and the Laparoendoscopic Single-Site Surgery Consortium for Assessment and Research to standardize the terminology to LESS in 2008. LESS was defined as "any minimally invasive surgical procedure that is performed through a single incision/location, using conventional laparoscopic or newly emerging instrumentation," adding that "it does not distinguish between a single laparoscopic port, multiple laparoscopic ports, or a single multi-port platform." Finally, it does not exclude "any procedure that requires enlargement of the access site for specimen extraction or removal." [4] The adoption of this new nomenclature in surgery has been variable with urologists being more inclined to comply.

With the initial reporting of the first LESS nephrectomy by Rane in 2007 and the limitations of instrumentation somewhat overcome by the availability of bent and articulating instruments many urologist have performed this procedure. [5] Widespread adoption however has been limited even in high-volume tertiary care centres. This is partly due to the steeper learning curve, poor ergonomics, and the general view that it holds little advantage over conventional laparoscopic surgery. Attempts have been made to improve ergonomics and to further lessen the learning curve by the insertion of additional 2 mm needle scopic ports. These instruments however have poor holding strength, small jaws, and no rotation. Magnetic anchoring and guidance systems have been described, but their use still remains experimental. [6] With the widespread availability of robotic platforms (Robotic-LESS) it is expected that the ergonomic barriers of LESS will be considerably lessened.

More concerning is the fact that available evidence has failed to show any real benefit to LESS compared to conventional laparoscopy. [7] Data however are retrospective and prospective trials are necessary. The exact position of LESS and its mainstream adoption will to large extent depend on these results.

In this issue of the Indian Journal of Urology we have a short symposium on LESS describing the state of the art and perhaps forecasting its role in the future.

Only the time would decide the role of LESS in the armamentarium of endourologist. I would like to express my gratitude to Dr. M.R Desai and Dr. P.B Rao for their help in guest editing this symposium.

This issue also has three videos which have won the prize at the USI annual meeting. But the response of the members to this section has been less than enthusiastic and I would request you all to send your videos, which may have educational value.

With best wishes,

   References Top

1.WheelessJr CR. Outpatient laparoscopesterilization under local anesthesia. Obstet Gynecol 1972;39:767-70.  Back to cited text no. 1
2.Inoue H, Takeshita K, Endo M. Singleportlaparoscopy assisted appendectomy under localpneumoperitoneum condition. Surg Endosc 1994;8:714-6.  Back to cited text no. 2
3.Sooriakumaran P, Kommu SS, Rane A. NOTES, SILS and OPUS: Battle of the acronyms for the future of laparoscopic urology. Int J Clin Pract 2008;62:988.  Back to cited text no. 3
4.Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo PG 2 nd , et al. Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 2010;24:762-8.  Back to cited text no. 4
5.Rané A, Rao P, Rao P. Single-port-access nephrectomy and otherlaparoscopic urologic using a novel laparoscopic port (R-port). Urology 2008;72:260-3.  Back to cited text no. 5
6.Best SL, Cadeddu JA. Development of magnetic anchoring and guidance systems for minimally invasive surgery. Indian J Urol 2010;26:418-22.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Raman JD, Bagrodia A, Cadeddu JA. Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: A comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 2009;55:1198-204.  Back to cited text no. 7


Print this article  Email this article


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (287 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


 Article Access Statistics
    PDF Downloaded206    
    Comments [Add]    

Recommend this journal