title: Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a 5-year, single-surgeon experience.
abstract: BACKGROUND
  Conventional laparoscopic nephrectomy (LN) is the gold standard approach for nephrectomy. An advance in minimally invasive nephrectomy is laparoendoscopic single-site nephrectomy (LESS-N).
  
  
  OBJECTIVE
  To compare 5-yr experience and outcomes of LESS-N to LN.
  
  
  METHODS
  Retrospective, case-control, single-surgeon series of 47 LESS-N cases matched in a 1:2 fashion by age, indication, and tumor size to 94 LN controls. LESS-N procedures were performed between August 2007 and February 2012 and LN procedures between December 1999 and 2009.
  
  
  METHODS
  LESS-N or LN.
  
  
  METHODS
  Categorical variables were compared by χ(2) analysis, and continuous variables were compared using the Mann-Whitney test.
  
  
  CONCLUSIONS
  There were significantly more female patients (66% vs 46%; p = 0.023) and a significantly lower median body mass index (24 kg/m(2) vs 28 kg/m(2); p < 0.001) in the LESS-N group compared with the LN group. Surgical indication was benign in 69 patients (23 LESS-N and 46 LN) and malignant in 72 patients (24 LESS-N and 48 LN). There were no significant differences for the LESS-N and LN groups, respectively, in mean operative time (149 min vs 150 min; p = 0.9), change in hematocrit (5.6% vs 4.8%; p = 0.661), change in creatinine (0.18 mg/dl vs 0.49 mg/dl; p = 0.18), analgesic use (morphine equivalents) (18.4 vs 17.5; p = 0.81), or intraoperative complication rates (6.4% vs 2.1%; p = 0.20). Length of stay was shorter (49 h vs 70 h; p = 0.017) and estimated blood loss was lower (56 ml vs 137 ml; p = 0.002) for the LESS-N group. Over a mean follow-up of 3 yr, postoperative complications (12.8% vs 7.4%; p = 0.30), disease-free survival (95.8% vs 87.5%; p = 0.384), and overall survival (91.7% vs 95.8%; p = 0.123) were not significantly different. The most significant limitation of this study is the retrospective design.
  
  
  CONCLUSIONS
  This series demonstrates that LESS-N is safe and durable in properly selected patients; however, multi-institutional randomized trials are required to confirm benefits.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Jodi A
authors.initials: JA
authors.lastname: Antonelli
authors.forename: Aditya
authors.initials: A
authors.lastname: Bagrodia
authors.forename: Christopher
authors.initials: C
authors.lastname: Odom
authors.forename: Ephrem O
authors.initials: EO
authors.lastname: Olweny
authors.forename: Steven
authors.initials: S
authors.lastname: Faddegon
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: Laparoendoscopic; Laparoscopic nephrectomy; Single port/incision