Objectives. To report the initial experience with incorporation of needlescopic (2 mm) instruments and optics in various therapeutic minimally invasive urologic procedures.

Methods. Needlescopic techniques were used to successfully perform a variety of urologic surgeries including adrenalectomy, nephrectomy, renal cyst marsupialization, orchiopexy, lymphocele marsupialization, and pelvic lymph node dissection.

Results. To date we have performed 42 needlescopic procedures in 39 patients (14 female and 25 male) ranging in age from 8 months to 87 years (mean 46.6 years). Three procedures were converted to conventional laparoscopy and one to open surgery, yielding a needlescopic success rate of 90.5%. Surgical times averaged 132 minutes and blood loss averaged 67 mL. Procedures were performed on an outpatient basis in 33.3% of cases, and 94.9% of patients were discharged home within 23 hours. The overall complication and conversion rate was 14.3% and there was no mortality.

Conclusions. Our initial experience is quite promising. In select patients, needlescopic urologic surgery is feasible and safe, and may reduce postoperative pain, hospital stay, and recovery time, and improve cosmesis. Further evaluation of, and improvement in, 2-mm instrumentation and optical technology is needed.