LESS: Upper tract, lower tract, and robotic surgery

Since the beginning of the laparoscopic surgery in urologic field, many kinds of urological surgeries have been performed laparoscopically. A laparo-endoscopic single-site surgery (LESS) using only one access port was devised due to the desire of doctors and patients to leave less wound and postoperative pain than conventional laparoscopic surgery, which needed multi-ports. Almost all urological laparoscopic operations have been tried and reported with single port due to the development of surgical instruments and techniques. However, it is still not mainly performed in many hospitals because of the drawbacks of long operation time and relatively long learning curve compared to conventional laparoscopic surgery. Recently, the frequency of LESS has been more decreasing because robot surgery has replaced many laparoscopic procedures. However, LESS is still one option of the most minimally invasive surgery for various urologic disease. In recent years, lots of robotic surgical systems are being developed based on single port, further development of LESS is expected. In this chapter, we will learn the history of urologic LESS and basic instruments. Further, most commonly performed urologic LESSs, such as radical nephrectomy, partial nephrectomy, pyeloplasty, and radical prostatectomy, would be described. We will also look into the recent status of robotic LESS and the robotic LESS systems to be developed in the future.