Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies.
BACKGROUND
Laparoendoscopic single-site (LESS) surgery has increasingly been used to perform radical, partial, simple, or donor nephrectomy to reduce the morbidity and scarring associated with surgical intervention. Studies comparing LESS nephrectomy (LESS-N) and conventional laparoscopic nephrectomy (CL-N) have reported conflicting results.


OBJECTIVE
To assess the current evidence regarding the efficiency, safety, and potential advantages of LESS-N compared with CL-N.


METHODS
We comprehensively searched PubMed, Embase, and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the two techniques.


RESULTS
Two RCTs and 25 retrospective studies including a total of 1094 cases were identified. Although LESS-N was associated with a longer operative time (weighted mean difference [WMD]: 9.87 min; 95% confidence interval [CI], 3.37-16.38; p=0.003) and a higher conversion rate (6% compared with 0.3%; odds ratio: 4.83; 95% CI, 1.87-12.45; p=0.001), patients in this group might benefit from less postoperative pain (WMD: -0.48; 95% CI, -0.95 to -0.02; p=0.04), lower analgesic requirement (WMD: -4.78 mg; 95% CI, -8.59 to -0.97; p=0.01), shorter hospital stay (WMD: -0.32 d; 95% CI, -0.55 to -0.09; p=0.007), shorter recovery time (WMD: -5.08 d; 95% CI, -8.49 to -1.68; p=0.003), and better cosmetic outcome (WMD: 1.07; 95% CI, 0.67-1.48; p<0.00001). Perioperative complications, estimated blood loss, warm ischemia time, and postoperative serum creatinine levels of graft recipients did not differ significantly between techniques.


CONCLUSIONS
LESS-N offers a safe and efficient alternative to CL-N with less pain, shorter recovery time, and better cosmetic outcome. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis.
Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
Xinxiang
X
Fan
Tianxin
T
Lin
Kewei
K
Xu
Zi
Z
Yin
Hai
H
Huang
Wen
W
Dong
Jian
J
Huang
D000700:Analgesics / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D052096:Warm Ischemia
D000700:Analgesics; D003404:Creatinine