title: Is laparoendoscopic single-site surgery a viable approach for radical nephrectomy with renal vein thrombus? Comparison with multiport laparoscopy.
abstract: OBJECTIVE
  To compare laparoendoscopic single-site surgery (LESS) and multiport laparoscopy (MPL) for radical nephrectomy and renal vein thrombectomy (RN-RVT) because concerns continue regarding the suitability of LESS for advanced renal tumors.
  
  
  METHODS
  We initiated a retrospective analysis of 26 patients who underwent RN-RVT (11 LESS, 15 MPL) between January 2006 and September 2011. LESS transperitoneal access was obtained by a periumbilical incision through which all trocars were inserted. LESS-RN-RVT recapitulated steps of MPL-RN-RVT, including stapled RVT and intact specimen extraction. Demographic factors and tumor characteristics, perioperative variables, and complications and outcomes were analyzed. Primary outcome was discharge visual analog pain score.
  
  
  RESULTS
  Median follow-up was 20.8 months. The 15 MPL cases were successfully completed laparoscopically; 1 of 11 LESS cases required insertion of an additional 5-mm port at a separate site. There were no significant demographic differences between the 2 groups. For LESS-RN-RVT and MPL-RN-RVT, mean tumor diameter was 7.1 and 7.9 cm (P = .346), mean RENAL nephrometry score was 10.2 and 10.5 (P = .407), mean operative time was 147 and 161 minutes (P = .331), and mean estimated blood loss was 122 and 170 mL (P = .282). Significantly lower visual analog pain score at discharge (1.1 vs 2.7, P = .001), narcotic requirement (8.3 vs 14 mg, P = .049), and hospital stay (2.6 vs 3.7 days, P = .032) were noted for LESS vs MPL patients. Both groups had negative margins. There were no significant differences in complications or transfusions or in disease-free and overall survival.
  
  
  CONCLUSIONS
  LESS was comparable to MPL-RN-RVT for perioperative parameters and may confer benefit with pain and hospital stay. Further study is requisite to establish the role of LESS in the management of renal neoplasms with RVT.
authors.affiliation: Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Park
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Kopp
authors.forename: Omer A
authors.initials: OA
authors.lastname: Raheem
authors.forename: Wassim M
authors.initials: WM
authors.lastname: Bazzi
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.forename: Kerrin L
authors.initials: KL
authors.lastname: Palazzi
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D012082:Renal Veins / Q000601:surgery*; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid