title: Laparoendoscopic single-site (LESS) varicocelectomy with reusable components: comparison with the conventional laparoscopic technique.
abstract: BACKGROUND
  This study aimed to compare laparoendoscopic single-site varicocelectomy (LESSV) with multiport laparoscopic varicocelectomy (MLV) in terms of intraoperative parameters and postoperative outcomes.
  
  
  METHODS
  A retrospective case-control study investigated 10 male adolescents and 89 adults who underwent either LESSV or MLV at the authors' center. The reusable X-Cone single port was inserted transumbilically. A 5-mm 30° telescope was used together with a straight and a prebent laparoscopic instrument. The MLV procedure was performed using two 5-mm ports and one 10-mm port.
  
  
  RESULTS
  Between January 2009 and November 2012, 20 patients underwent LESSV and 79 patients underwent MLV. The demographic data were comparable between the two groups. The mean operating time was 59.1 ± 15.5 min for LESSV and 51.2 ± 14.4 min for MLV (P = 0.04). In the LESSV group, no conversion to MLV was necessary. The hospital stay was 1.6 ± 0.7 days in the LESSV group versus 1.8 ± 0.5 days in the MLV group (P = 0.17). The postoperative pain scores did differ between the two groups. By day 2, significantly more patients in the LESSV group than in the MLV group fully recovered their normal physical activity (P = 0.02). Comparison of pre- and postoperative values showed relief of testicular pain and improvement of semen parameters for the majority of the patients. The overall incidence of complications was distributed equally between the two groups as follows: paresthesia of the upper thigh (8 %), wound infection (5 %), epididymitis (3 %) and hydrocele (4 %). All the patients in the LESSV group were fully satisfied with their cosmetic results compared with only 76 % of the patients in the MLV group (P = 0.01).
  
  
  CONCLUSIONS
  The LESSV procedure performed with the reusable X-Cone is as safe and efficient as MLV. After LESSV, the parameters measuring postoperative patient satisfaction are significantly improved. Given its reusable components, including prebent laparoscopic instruments, the X-Cone platform is a cost-effective alternative to disposable or homemade single ports.
authors.affiliation: Department of Urology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany, frank.friedersdorff@charite.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Friedersdorff
authors.forename: Seven Johannes
authors.initials: SJ
authors.lastname: Aghdassi
authors.forename: Peter
authors.initials: P
authors.lastname: Werthemann
authors.forename: Hannes
authors.initials: H
authors.lastname: Cash
authors.forename: Irena
authors.initials: I
authors.lastname: Goranova
authors.forename: Jonas Felix
authors.initials: JF
authors.lastname: Busch
authors.forename: Jan
authors.initials: J
authors.lastname: Ebbing
authors.forename: Stefan
authors.initials: S
authors.lastname: Hinz
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: Joerg
authors.initials: J
authors.lastname: Neymeyer
authors.forename: Tom Florian
authors.initials: TF
authors.lastname: Fuller
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D017743:Equipment Reuse; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology; D010292:Paresthesia / Q000453:epidemiology / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D055101:Semen Analysis; D013530:Surgical Wound Infection / Q000453:epidemiology; D013536:Suture Techniques; D006848:Testicular Hydrocele / Q000453:epidemiology / Q000209:etiology; D014472:Umbilicus; D014646:Varicocele / Q000601:surgery*; D055815:Young Adult
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