Laparo-endoscopic single-site surgery for radical and cytoreductive nephrectomy, renal vein thrombectomy, and partial nephrectomy: a prospective pilot evaluation.
Introduction. Laparo-endoscopic single-site surgery (LESS) may diminish morbidity of laparoscopic surgery. We prospectively evaluated feasibility and outcomes of LESS-Radical Nephrectomy (LESS-RN) and Partial Nephrectomy (LESS-PN). Methods. 10 patients underwent LESS-RN (6) and LESS-PN (4) between 2/2009-5/2009. LESS-RN included 2 with renal vein thrombectomy, one of which was also cytoreductive. Transperitoneal LESS access was obtained by periumbilical incision. Patient/tumor characteristics, oncologic, and quality of life (QoL) outcomes were analyzed. Results. 3 Men/7 Women (mean age 58.7 years, median follow-up 9.8 months) underwent LESS. 9/10 cases were completed successfully. All had negative margins. Mean operative time was 161 minutes, estimated blood loss was 125 mL, and incision size was 4.4 cm. Median tumor size for LESS-RN and -PN was 5.0 and 1.7 cm (P = .045). Median LESS-PN ischemia time was 24 minutes; mean preoperative/postoperative creatinine were 0.7/0.8 mg/dL (P = .19). Mean pain score at discharge was 1.3. Mean preoperative, 3-, and 6-month postoperative SF-36 QoL Score was 73.8, 74.4 and 77.1 (P = .222). All patients are currently alive. Conclusions. LESS-RN, renal vein thrombectomy, and PN are technically feasible and safe while maintaining adherence to oncologic principles, with excellent QoL preservation and low discharge pain scores. Further study is requisite.
Derweesh
Ithaar H
IH
Division of Urology, Department of Surgery, University of California, San Diego School of Medicine, San Diego, CA 92103, USA.
Silberstein
Jonathan L
JL
Bazzi
Wassim
W
Kopp
Ryan
R
Downs
Tracy M
TM
Kane
Christopher J
CJ