title: Percutaneous Externally Assembled Laparoscopic vs Laparoendoscopic Single-Site Nephrectomy in a Porcine Model: A Prospective, Randomized, Blinded, Study.
abstract: To compare the outcomes between laparoendoscopic single-site (LESS) and a novel percutaneous externally assembled laparoscopic (PEAL) nephrectomy in an in vivo porcine model.
  
  
  
  Ten female farm pigs were randomized to LESS nephrectomy (5) or PEAL nephrectomy (5). Operative times, estimated blood loss, and intraoperative and postoperative complications were compared. The surgeons used a Likert scale to grade difficulty of peritoneal access, port placement, tool assembly, hilar dissection, closure, and overall difficulty of surgery. Scar assessment was performed by a blinded plastic surgeon using the Vancouver Scar Scale. Descriptive statistics were reported as median and range. The Mann-Whitney U test was used for continuous and ordinal variables. A p value <0.05 was considered significant.
  
  
  
  Median operative time was significantly shorter in the PEAL group vs the LESS group (85 minutes vs 127 minutes, p = 0.03). Median Likert scores showed overall hilar dissection and nephrectomy to be significantly easier using PEAL compared with LESS (2 vs 9, p < 0.01 for both). The PEAL instruments left no visible scar at 5 feet in any animal, and only 1 out of 10 scars could be identified on physical examination.
  
  
  
  The PEAL surgical paradigm demonstrates nearly scarless outcomes while providing shorter operative times and easier performance than LESS nephrectomy in a porcine model.
authors.affiliation: 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Keheila
authors.affiliation: 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: Jim K
authors.initials: JK
authors.lastname: Shen
authors.affiliation: 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: Daniel
authors.initials: D
authors.lastname: Faaborg
authors.affiliation: 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: Patrick
authors.initials: P
authors.lastname: Yang
authors.affiliation: 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: Salim
authors.initials: S
authors.lastname: Cheriyan
authors.affiliation: 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: Samuel
authors.initials: S
authors.lastname: Abourbih
authors.affiliation: 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: Nazih
authors.initials: N
authors.lastname: Khater
authors.affiliation: 2 Department of Plastic Surgery, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Hill
authors.affiliation: 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California.
authors.forename: D Duane
authors.initials: DD
authors.lastname: Baldwin
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002921:Cicatrix / Q000473:pathology; D004195:Disease Models, Animal; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D034421:Sus scrofa; D013552:Swine
keywords: laparoscopy; minimally invasive surgical procedures; nephrectomy