A matched-pair comparison of laparoendoscopic single-site surgery and standard laparoscopic radical nephrectomy by a single urologist.
OBJECTIVE
The aim of this study is to compare the perioperative outcomes after transumbilical laparoendoscopic single-site (LESS) radical nephrectomy (LESS-RN) performed by a surgeon during his learning curve of this novel procedure with the outcomes after standard laparoscopic radical nephrectomy (LRN) for patients with a solitary renal tumor. Using this information, we examined whether LESS exhibits any objective advantages over standard laparoscopy.


METHODS
Twenty patients who underwent LESS-RN for a solitary cT(1)N(0)M(0) renal mass (group 1) were matched and compared with 33 patients who underwent standard LRN (group 2) for tumors of similar sizes. Patient and surgical data, pathologic outcomes, and follow-up information, including patient responses regarding cosmetic satisfaction, were analyzed.


RESULTS
The minimum duration of follow-up was 6 months for both groups. Patients in group 1 had significantly (P<0.05) quicker recoveries of bowel function, shorter postoperative analgesic time, and lower pain scores during their hospital stay. At the time of the last follow-up, all patients remained symptom free, and no evidence of recurrence was detected. Compared with that of standard LRN patients, LESS-RN patients exhibited better cosmetic satisfaction scores postoperatively at least to 6 months (P=0.013).


CONCLUSIONS
Transumbilical LESS-RN is a feasible, safe, and efficacious procedure with favorable perioperative outcomes that results in significantly improved control of postoperative pain, more rapid recovery of bowel function, and increased cosmetic satisfaction. Additional research, including randomized controlled trials and long-term follow-ups, however, will be needed to draw solid conclusions regarding the relative efficacy of this procedure compared with standard approaches.
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Linhui
L
Wang
Bing
B
Liu
Zhenjie
Z
Wu
Qing
Q
Yang
Wei
W
Chen
Zunli
Z
Xu
Cheng
C
Wang
Liang
L
Xiao
Fubo
F
Wang
Yinghao
Y
Sun
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000592:standards*; D010537:Peritoneum / Q000601:surgery; D019651:Plastic Surgery Procedures; D012015:Reference Standards; D016896:Treatment Outcome; D014572:Urology