title: Staging lymphadenectomy in patients with localized high risk prostate cancer: comparison of the laparoendoscopic single site (LESS) technique with conventional multiport laparoscopy.
abstract: BACKGROUND
  In patients with localized high-risk prostate cancer awaiting radiation therapy, pelvic lymphadenectomy (PL) is a reliable minimally invasive staging procedure. We compared outcomes after laparoendoscopic single site PL (LESSPL) with those after conventional multiport laparoscopic PL (MLPL).
  
  
  METHODS
  A retrospective case-control study was carried out at the authors' center. For LESSPL the reusable X-Cone single port was combined with straight and prebent laparoscopic instruments and an additional 3 mm needlescopic grasper. MLPL was performed via four trocars of different sizes using standard laparoscopic instruments.
  
  
  RESULTS
  Patients who underwent either LESSPL (n = 20) or MLPL (n = 97) between January 2008 and July 2013, were included in the study. Demographic data were comparable between groups. Patients in the LESSPL group tended to be older and had a significantly higher ASA-score. The mean operating time was 172.4 ± 34.1 min for LESSPL and 116.6 ± 40.1 min for MLPL (P < .001). During LESSPL, no conversion to MLPL was necessary. An average of 12 lymph nodes per patient was retrieved, with no significant difference between study groups. Postoperative pain scores were similar between groups. The hospital stay was 2.3 ± 0.7 days after LESSPL and 3.1 ± 1.2 days after MLPL (P = .01). Two days postoperatively, significantly more patients after LESSPL than after MLPL recovered their normal physical activity (P < .001). Six months postoperatively, no complications were registered in the LESSPL group and cosmetic results were excellent.
  
  
  CONCLUSIONS
  In the present study, shorter hospitalization and quicker postoperative recovery were major benefits of LESSPL over MLPL. In patients with localized prostate cancer, staging LESS pelvic lymphadenectomy may be a safe alternative to conventional multiport laparoscopy.
authors.affiliation: Department of Urology, Charité University Hospital, 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: Ahmed
authors.initials: A
authors.lastname: Magheli
authors.forename: Maximilian
authors.initials: M
authors.lastname: Richter
authors.forename: Carsten
authors.initials: C
authors.lastname: Stephan
authors.forename: Jonas
authors.initials: J
authors.lastname: Busch
authors.forename: Dirk
authors.initials: D
authors.lastname: Boehmer
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: T Florian
authors.initials: TF
authors.lastname: Fuller
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000295:instrumentation / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors