title: Comparison of laparoendoscopic single-site (LESS) and multiport laparoscopic radical nephrectomy for clinical T1b and T2a renal masses.
abstract: BACKGROUND
  The aim of this study was to compare outcomes of laparoendoscopic single-site surgery (LESS) and multiport laparoscopic (MPL) radical nephrectomy (RN) for clinical T1b/T2a renal masses, as concerns continue regarding suitability and benefit of LESS for larger renal masses.
  
  
  METHODS
  Retrospective single-surgeon comparison of LESS- and MPL-RN between 7/2005 and 11/2014. Sixty-three patients underwent LESS-RN (44 cT1b/19 cT2a); 133 underwent MPL (83 cT1b/50 cT2a). All patients were managed with a standardized care pathway. Primary outcome was length of hospital stay (LOS). Secondary outcomes included operative time, estimated blood loss (EBL), complications, discharge pain score (visual analog pain, VAP), narcotic requirement (morphine equivalents, MSO4eq).
  
  
  RESULTS
  130/133 MPL and 62/63 LESS were successfully performed. For MPL and LESS groups: mean tumor diameter (cm) for cT1b was 5.3 vs. 5.4 (P=0.689); and for cT2a was 8.2 vs. 8.3 (P=0.728); mean OR time (min) was 126.3 vs. 132.7 (P=0.314); mean EBL (mL) was 139.5 vs.127.8 (P=0.49). No significant differences in complications were noted (P=0.781). LESS was associated with significant reductions in LOS (2.14 vs. 2.45 days, P=0.043), discharge VAP (1.3 vs. 2.2, P<0.001), and narcotic use (5.9 vs. 10.7 MSO4eq, P<0.001).
  
  
  CONCLUSIONS
  LESS is comparable to MPL-RN for cT1b and T2a renal tumors in terms of perioperative parameters and may confer benefit with respect to LOS and analgesic requirement.
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Abd-El R
authors.initials: AR
authors.lastname: Hassan
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Omer A
authors.initials: OA
authors.lastname: Raheem
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Berquist
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Alp T
authors.initials: AT
authors.lastname: Beksac
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Bloch
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Field
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Urology, and University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Holden
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: McDonald
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Hamilton
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Liss
authors.affiliation: Department of Urology, UC San Diego Health System, La Jolla, CA, USA - iderweesh@gmail.com.
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies