title: Comparison of laparoendoscopic single-site and multiport laparoscopic radical and partial nephrectomy: a prospective, nonrandomized study.
abstract: OBJECTIVE
  To prospectively compare outcomes of laparoendoscopic single-site and multiport laparoscopic radical nephrectomy and partial nephrectomy, focusing on postoperative pain and analgesic requirement.
  
  
  METHODS
  Nonrandomized, prospective comparison of laparoendoscopic single-site and multiport laparoscopic radical nephrectomy and partial nephrectomy. Thirty-four patients underwent laparoendoscopic single-site (17 radical nephrectomy/17 partial nephrectomy); 42 underwent multiport laparoscopy (28 radical nephrectomy/14 partial nephrectomy) from February 2009 to February 2010. Laparoendoscopic single-site transperitoneal access was obtained by periumbilical incision through which all trocars were inserted. Laparoendoscopic radical nephrectomy/partial nephrectomy recapitulated steps of multiport laparoscopic radical nephrectomy/partial nephrectomy. Demographics/tumor characteristics, outcomes, and complications were analyzed.
  
  
  RESULTS
  Forty-two of 42 multiport laparoscopic and 32/34 laparoendoscopic single-site cases were successfully performed. Mean follow-up was 16.2 months. For laparoendoscopic single-site and multiport laparoscopy groups mean operating room time (min) was 159.3 vs 158.9 (P = .952); mean estimated blood loss (mL) was 175.7 vs 156.1 (P = .553); percent transfused was 2.9% vs 0% (P = .925). No significant differences in complications were noted (P = .745). Significant decrease in analgesic use (6 morphine equivalents vs 11.6, P < .001) and discharge pain score (1.7 vs 2.7, P < .01) were noted in laparoendoscopic single-site vs multiport laparoscopic radical nephrectomy. For laparoendoscopic single-site partial nephrectomy and multiport laparoscopic partial nephrectomy, no significant differences were noted for tumor diameter (1.8 vs 2.0 cm, P = .57), RENAL score (0.962), ischemia time (28.6 vs 27.5 minutes, P = .70), and preoperative (P = .78)/postoperative creatinine (P = .32). For laparoendoscopic single-site radical nephrectomy and multiport laparoscopic radical nephrectomy, no significant differences were noted for mean tumor diameter (5.6 vs 5.3 cm, P = .63), RENAL score (P = .815), and mean operative time (142.3 vs 155.4 minutes P = .13).
  
  
  CONCLUSIONS
  In this well-matched, prospective comparison, laparoendoscopic single-site is comparable with multiport laparoscopic surgery in terms of perioperative parameters and may confer benefit with respect to analgesic requirement. Randomized evaluation and longer-term follow-up are necessary.
authors.affiliation: Department of Surgery/Division of Urology, University of California, San Diego School of Medicine, La Jolla, CA 90293-0987, USA.
authors.forename: Wassim M
authors.initials: WM
authors.lastname: Bazzi
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Kopp
authors.forename: Seth A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Kyoko
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome