Laparoendoscopic single-site pyeloplasty: a comparison with the standard laparoscopic technique.
OBJECTIVE
• To compare laparoendoscopic single-site (LESS) and standard laparoscopic pyeloplasty procedures with the aim of defining whether perioperative, recovery or health-related quality of life (HRQL) benefits exist for the LESS procedure.


METHODS
• From November 2007 to August 2008, sixteen patients underwent LESS pyeloplasty at a tertiary care referral centre. These patients were compared with a matched cohort of patients undergoing standard laparoscopic pyeloplasty. • Matching criteria included gender and age (within 10 years), as well as preoperative degree of obstruction (T(½) within 15 min) and differential renal function (within 10% ipsilaterally) based on diuretic radionuclide scanning. Mean follow-up was 13 ± 4 months for the LESS group and 17 ± 3 months for the standard laparoscopic group. • LESS pyeloplasty procedures were all performed using a single-port device in the umbilicus and suturing was assisted with a 2-mm grasping instrument. Perioperative variables, successful relief of obstruction and HRQL measurements were compared between the two groups.


RESULTS
• Except for a lower body mass index in the LESS group (23 ± 6 kg/m² vs 30 ± 7 kg/m², P = 0.002), no difference was noted for perioperative variables between the two cohorts, including hospital stay and analgesic requirement. • No significant HRQL advantage was noted for either group based on a six-item non-validated questionnaire. • All patients in both groups experienced clinical resolution of their symptoms. A patient in the standard laparoscopy group and two patients in the LESS group had T(½) > 20 min (0.063% vs 0.125%, P= 1.00) on diuretic radionuclide scanning. • Limitations include the retrospective nature of the present study, as well as the relatively small study population and short follow-up.


CONCLUSIONS
• No benefit was noted for LESS pyeloplasty over the standard laparoscopic procedure beyond aesthetic advantages. • Further comparisons are needed to determine whether these results are generalizable to other LESS procedures.
Stein
Robert J
RJ
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Berger
Andre K
AK
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Brandina
Ricardo
R
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Patel
Neil S
NS
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Canes
David
D
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Irwin
Brian H
BH
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Aron
Monish
M
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Autorino
Riccardo
R
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Shah
Gaurang
G
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
Desai
Mihir M
MM
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, University of Southern California, Los Angeles, CALahey Clinic, Burlington, MAUniversity of Vermont, Burlington, VT, USA.
D000328:Adult; D004812:Epidemiologic Methods; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D012371:Robotics; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult