title: A prospective randomized comparison of traditional laparoendoscopic single-site surgery with needlescopic-assisted laparoscopic nephrectomy in the porcine model.
abstract: OBJECTIVE
  Laparoendoscopic single-site (LESS) surgery produces virtually no scar but is technically challenging because of the loss of triangulation. The objective of this study is to compare classic transumbilical LESS nephrectomy with needlescopic-assisted laparoscopy (NAL) surgery. In doing so, we evaluated whether the addition of a single 2-mm subcostal port could restore triangulation while not jeopardizing recovery or cosmetic outcome in the porcine model.
  
  
  METHODS
  Ten female farm pigs were randomized to laparoscopic nephrectomy with either LESS or NAL. In LESS, a TriPort was placed through a single 2.5-cm umbilical incision. In NAL, 5- and 10-mm ports were placed in the umbilicus and a 2-mm port was placed in the midclavicular line. Preoperative, perioperative, and postoperative parameters were compared. Variables were analyzed with the Wilcoxon signed-rank test and two-tailed Fisher exact test. Cosmesis was evaluated objectively using the Vancouver Scar Scale and subjectively by a blinded dermatologist. A cost analysis was performed.
  
  
  RESULTS
  Estimated blood loss was minimal in both groups (28.8 mL in LESS and 9.4 mL in NAL). Operative time was significantly shorter in NAL (103 vs 150 min; P<0.001). There was no difference in complications (2 vs 1; P=0.500), objective cosmesis (3.9 vs 3.8; P>0.2), or subjective cosmesis (2 vs 3; P=0.500). The NAL protocol had significantly lower disposable equipment costs ($363 vs $1696).
  
  
  CONCLUSIONS
  The addition of a 2-mm subcostal port and the restoration of triangulation in the NAL protocol enable shorter operative times, increased surgeon comfort, improved technical ease, and lower costs while maintaining the scarless cosmesis of the traditional LESS protocol.
authors.affiliation: Department of Urology, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
authors.forename: Lesli I
authors.initials: LI
authors.lastname: Nicolay
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Bowman
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Heldt
authors.forename: Forrest C
authors.initials: FC
authors.lastname: Jellison
authors.forename: Neda
authors.initials: N
authors.lastname: Mehr
authors.forename: Christopher
authors.initials: C
authors.lastname: Tenggardjaja
authors.forename: William
authors.initials: W
authors.lastname: Millard
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Koning
authors.forename: D Duane
authors.initials: DD
authors.lastname: Baldwin
mesh_terms: D000818:Animals; D004209:Disposable Equipment / Q000191:economics; D005260:Female; D010535:Laparoscopy / Q000191:economics / Q000295:instrumentation* / Q000379:methods*; D023421:Models, Animal; D009392:Nephrectomy / Q000191:economics / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D034421:Sus scrofa / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome