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Abstract
Introduction and Objectives: It has been established that robotic-assisted laparoscopic surgery has several advantages when compared with standard laparoscopic surgery. Optics, ergonomics, dexterity and precision are all enhanced with the use of a robotic platform. For these reasons, it was postulated that the application of robotics to laparoendoscopic single-site surgery (LESS) could overcome some of the constraints seen with the conventional laparoscopic approach. Issues such as instrument clashing, inability to achieve effective triangulation for dissection and difficulties with intracorporeal suturing have limited the widespread adoption of conventional LESS. The application of robotics has eliminated many of the constraints experienced with conventional LESS; however, challenges still remain. Materials and Methods: A systematic literature review was performed using PubMed to identify relevant studies. There were no time restrictions applied to the search, but only studies in English were included. We used the following search terms: Robotic single site surgery, robotic single port surgery, robotic single incision surgery and robotic laparoendoscopic single site surgery. Results: A number of centers have published their experience with robotic-laparoendoscopic single-site surgery (R-LESS); however, no prospective studies exist. What is clear is that R-LESS minimizes several of the difficulties experienced with conventional LESS, including intracorporeal suturing and triangulation during dissection. Outcomes are comparable to standard robotic surgery, with a trend toward improved cosmesis and reduced pain. However, a significant advantage with regard to these two factors has yet to be demonstrated. Conclusions: R-LESS is technically feasible and the benefits of robotic surgery eliminate many of the challenges seen with conventional LESS. However, despite the advantages of the robotic platform, R-LESS is not free of challenges. Instrument clashing remains an issue due to the bulky profile of the current robotic system. Other issues include lack of space for the assistant at the bedside, inability to incorporate the 4th robotic arm for retraction and difficulties with triangulation. Although solutions for some of these issues are currently under development, R-LESS is still very much in its infancy.
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Affiliation(s)
- Dinesh Samarasekera
- Department of Urology, Center for Robotic and Laparoscopic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad H Kaouk
- Department of Urology, Center for Robotic and Laparoscopic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Autorino R, Brandao LF, Sankari B, Zargar H, Laydner H, Akça O, De Sio M, Mirone V, Chueh SCJ, Kaouk JH. Laparoendoscopic single-site (LESS) vs laparoscopic living-donor nephrectomy: a systematic review and meta-analysis. BJU Int 2014; 115:206-15. [DOI: 10.1111/bju.12724] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
- Urology Unit; Second University of Naples; Naples Italy
| | - Luis Felipe Brandao
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Bashir Sankari
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
- Department of Surgical Subspecialties; Cleveland Clinic Abu Dhabi; Abu Dhabi UAE
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Humberto Laydner
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Oktay Akça
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Marco De Sio
- Urology Unit; Second University of Naples; Naples Italy
| | | | - Shih-Chieh J. Chueh
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
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Tzanis D, Lainas P, Tranchart H, Pourcher G, Devaquet N, Perlemuter G, Naveau S, Dagher I. Atypical as well as anatomical liver resections are feasible by laparoendoscopic single-site surgery. Int J Surg Case Rep 2014; 5:580-3. [PMID: 25108073 PMCID: PMC4200877 DOI: 10.1016/j.ijscr.2013.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/28/2013] [Accepted: 11/15/2013] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Liver surgery was one of the last fields to be conquered by laparoscopy, which has become safe and effective, especially for left lateral sectionectomy (LLS) and limited peripheral resections. However, major hepatectomies remain challenging. Laparoendoscopic single-site (LESS) surgery is being employed for an increasing variety of surgical sites and indications. PRESENTATION OF CASE Three patients underwent LESS hepatectomy. A 36-year-old woman had LLS for a 38-mm adenoma, an 85-year-old woman an atypical resection of segment VI for a 12-mm hepatocellular carcinoma and a 41-year-old woman an atypical right anterior resection for a 9 cm symptomatic FNH. Procedures were performed transperitoneally with a single-port device, via a 20-mm or 30-mm incision. Operative times were 110 min for LLS, 100 min for the atypical segment VI resection and 120 min for the atypical right anterior liver resection. Blood loss was less than 50 ml in the first two patients and 150 ml in the third. Postoperative courses were uneventful. The first two patients were discharged on postoperative day 3 and the third on postoperative day 1. DISCUSSION To date, some case reports and series of LESS liver surgery have been published. We performed the reported hepatectomies after a considerable experience in laparoscopic hepatic surgery and after applying the LESS approach to other procedures. Our hepatectomy technique was not modified by the use of the single-port and results were very encouraging. CONCLUSION We believe that in selected patients, both peripheral resections and LLS are feasible by LESS surgery, with good intra-operative and post-operative results.
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Affiliation(s)
- Dimitrios Tzanis
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France
| | - Panagiotis Lainas
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France
| | - Hadrien Tranchart
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France
| | - Guillaume Pourcher
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France
| | - Niaz Devaquet
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France
| | - Gabriel Perlemuter
- University of Paris-Sud, Orsay F-91405, France; Department of Gastroenterology, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France
| | - Sylvie Naveau
- University of Paris-Sud, Orsay F-91405, France; Department of Gastroenterology, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France
| | - Ibrahim Dagher
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France.
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McCrory B, LaGrange CA, Hallbeck M. Quality and safety of minimally invasive surgery: past, present, and future. Biomed Eng Comput Biol 2014; 6:1-11. [PMID: 25288906 PMCID: PMC4147776 DOI: 10.4137/becb.s10967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 12/14/2022] Open
Abstract
Adverse events because of medical errors are a leading cause of death in the United States (US) exceeding the mortality rates of motor vehicle accidents, breast cancer, and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors because they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery (MIS) has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. To mitigate errors and protect patients, a multidisciplinary approach is needed to improve MIS. Clinical human factors, and biomedical engineering principles and methodologies can be used to develop and assess laparoscopic surgery instrumentation, practices, and procedures. First, the foundational understanding and the imperative to transform health care into a high-quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. Finally, the future of this field and the research needed to further improve the quality and safety of MIS is discussed.
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Affiliation(s)
- Bernadette McCrory
- Mechanical and Materials Engineering Department, University of Nebraska, Lincoln, NE, USA
| | - Chad A LaGrange
- Division of Urologic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ms Hallbeck
- Mechanical and Materials Engineering Department, University of Nebraska, Lincoln, NE, USA. ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Health Care Policy and Research Department, Mayo Clinic, Rochester, MN, USA
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Zou X, Zhang G, Xue Y, Yuan Y, Xiao R, Wu G, Wang X, Wu Y, Long D, Yang J, Xu H, Liu F, Liu M. Transumbilical multiport laparoscopic nephrectomy with specimen extraction through the vagina. Urol Int 2014; 92:407-13. [PMID: 24732939 DOI: 10.1159/000356099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 09/30/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To report our initial experience with transumbilical multiport laparoscopic nephrectomy (TMLN) with transvaginal specimen extraction. PATIENTS AND METHODS Between January and July 2010, 5 married and parous female patients were submitted to TMLN with transvaginal specimen extraction in our center. All data referring to patient demographics, surgery, pathology and perioperative outcomes were recorded. Sexual function was assessed with the Female Sexual Function Index questionnaire before and after surgery. The cosmetic result was investigated by administering the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS All procedures were completed successfully. The mean operative time was 136 min (range 110-160 min, standard deviation [SD] 20.7). The mean estimated blood loss was 66 ml (range 40-100 ml, SD 24.1). The mean postoperative hospitalization stay was 4.8 days (range 4-6 days, SD 0.8). All patients reported unaltered sexual function after surgery. The better cosmetic results were confirmed by the PSAQ score. CONCLUSIONS TMLN with transvaginal specimen extraction is feasible and safe for married and parous female patients. This technique is a natural evolution towards natural orifice transluminal endoscopic surgery (NOTES). By acting as an intermediate-type procedure, it provides a bridge through which NOTES may ultimately gain clinical acceptance.
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Affiliation(s)
- Xiaofeng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
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Esposito C, Najmaldin A, Schier F, Yamataka A, Ferro M, Riccipetitoni G, Czauderna P, Ponsky T, Till H, Escolino M, Iaquinto M, Marte A, Saxena A, Settimi A, Rothenberg S. Work-related upper limb musculoskeletal disorders in pediatric minimally invasive surgery: a multicentric survey comparing laparoscopic and sils ergonomy. Pediatr Surg Int 2014; 30:395-9. [PMID: 24292427 DOI: 10.1007/s00383-013-3437-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Surgeons are at risk for developing work-related musculoskeletal symptoms (WMS). The present study aims to compare laparoscopy and SILS ergonomy among pediatric surgeons. METHODS A questionnaire formed by 17 questions was mailed to 14 pediatric surgeons, seven with a large experience in laparoscopy and seven in SILS. All surgeons completed the survey. The questionnaires were focused on the type of laparoscopic or SILS activity, location and type of pain, need for drugs and its physical consequences. Results were analyzed using χ(2) test. RESULTS Results indicated a similar incidence of WMS with shoulder symptoms (>75%) in both groups. In laparoscopic group this pain is evident only after a long lasting procedure, while in SILS group the pain is present after each procedure performed. SILS surgeons used painkillers and other therapies statistically more frequently than laparoscopic group (χ(2) = 0.001). CONCLUSIONS This study confirms there is a strong association between WMS and MIS surgery. The incidence of pain is similar in both groups. Pain was present only after long lasting procedures in laparoscopic group, while SILS surgeons have pain after each procedure performed. In addition SILS surgeons use more frequently painkillers and other therapies compared to laparoscopic surgeons. In conclusion, it seems that SILS has a worse ergonomy compared to laparoscopy.
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Affiliation(s)
- Ciro Esposito
- "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy,
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Jung JW, Cha WH, Lee BK, Lee S, Lee SB, Lee SE, Jeong CW. Laparoendoscopic Single-Site Surgery Using Innovative Articulating Instruments: Preclinical Evaluation of the Prototype. J Endourol 2014; 28:281-5. [DOI: 10.1089/end.2013.0510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jin-Woo Jung
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Heon Cha
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Ki Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Seung Bae Lee
- Department of Urology, Seoul National University Boramae Hospital, Seoul, Korea
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, College of Medicine, Seoul National University, Seoul, Korea
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[Study of laparoendoscopic single-site surgery (LESS) for urachal remnants in our department]. Nihon Hinyokika Gakkai Zasshi 2014; 104:697-701. [PMID: 24564076 DOI: 10.5980/jpnjurol.104.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined laparoendoscopic single-site surgery (LESS) for urachal remnants and evaluated its usefulness and efficacy. PATIENTS AND METHODS From August 2011 to July 2012, we underwent this surgery for 5 patients (3 males, 2 females). The mean age was 30.8 (25-36) years old. A 2 cm incision was made around the umbilicus and Access Platform was placed. The entire urachal tissues were excised, and this 2 cm incison was reshaped as the umbilicus. RESULTS The median operative time was 220 (156-460) minutes, and the median operative blood loss was 10 (10-70) ml. They had no operative complications, and were discharged 6 (5-14) days after surgery. CONCLUSIONS Our surgical procedures have very excellent cosmesis and advantages in particular for young because we reshape as the umbilicus the surgical wound. We think that this surgery can be performed safe and effectively for surgeons trained in the conventional laparoscopic procedures.
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Inoue S, Ikeda K, Kobayashi K, Kajiwara M, Teishima J, Matsubara A. Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: Laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy. Can Urol Assoc J 2014; 8:E20-5. [PMID: 24454596 DOI: 10.5489/cuaj.1543] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We evaluate patient-reported satisfaction and cosmesis of laparoendoscopic single-site adrenalectomy (LESS-A) in comparison with that of conventional laparoscopic adrenalectomy (CLA). METHODS A total of 19 and 104 patients who respectively underwent LESS-A and CLA between May 1996 and June 2011 were included in the study. Questionnaires inquiring about scar pain (0: not painful, 10: very painful), satisfaction (0: not satisfied, 10: very satisfied) and cosmesis (0: very unsightly, 10: very beautiful) on the basis of a visual analogue scale were sent to patients postoperatively. RESULTS The respondents consisted of 11 and 54 patients who underwent LESS-A and CLA, respectively. There was no significant inter-group difference in age, sex, affected side or body mass index. No significant differences were observed in operative time or estimated blood loss. There were also no significant differences in pain (0.67 vs. 0.57, p = 0.393), satisfaction (8.92 vs. 8.46, p = 0.453), or cosmesis score (8.58 vs. 8.00, p = 0.487) between the LESS-A and CLA groups overall. In female patients, the satisfaction score was significantly higher in the LESS-A group than in the CLA group (10.0 vs. 8.72, p = 0.049). In young patients (<50 years old), the satisfaction score was also significantly higher in the LESS-A group than in the CLA group (9.17 vs. 6.38, p = 0.036). CONCLUSIONS Young patients and female patients who had received LESS-A adrenal surgery were more satisfied with the scar outcomes than were the young patients and female patients who had received CLA. We suggest that this patient subset most values the cosmetic benefits of LESS-A.
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Affiliation(s)
- Shogo Inoue
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kenichiro Ikeda
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kanao Kobayashi
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Mitsuru Kajiwara
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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García-Tello A, Cabrera PM, Cáceres F, Ramón de Fata F, Mateo E, Angulo JC. Umbilical laparoendoscopic urological surgery with a novel reusable device. Scand J Urol 2014; 48:301-8. [PMID: 24446863 DOI: 10.3109/21681805.2013.876096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aims of this study were to present cumulative experience with umbilical laparoendoscopic urological surgery using a reusable device and to evaluate outcomes and complications in the first 100 patients. MATERIAL AND METHODS Patients undergoing umbilical surgery with the KeyPort system and DuoRotate instruments (Richard Wolf, Knittlingen, Germany) were evaluated prospectively. Demographic, intraoperative and postoperative data were assessed. RESULTS Between October 2011 and July 2012, 79 pelvic (66 radical prostatectomy, 10 radical cystectomy, one diverticulectomy, one bilateral orchiectomy, one ureter reimplantation) and 21 renal (seven radical nephrectomy, six partial nephrectomy, five nephroureterectomy, two pyeloplasty, one pyelolithotomy) surgeries were performed through the umbilicus using this platform. Follow-up was 56.7 ± 12.6 weeks (mean ± SD). Mean age was 64.3 ± 10.3 years, body mass index 29 ± 4.6 kg/m(2), operative time 232 ± 106 min and estimated blood loss 260 ± 95 ml. Conversion to standard multiport laparoscopy was not necessary. An accessory port was used in 87 cases to facilitate suturing and conduct drainage extraction. Postoperative complications occurred in 24 cases (six Clavien grade I, 12 grade II, one grade IIIa, two grade IIIb, two grade IVa, one grade IVb). Mean hospital stay was 4.2 ± 4 days. Total transfusion rate was 10%. Mean visual analogue pain scale at day 2 was 2.1 ± 1.3 (0-10). Visual analogue wound satisfaction scale at month 1 was 9.2 ± 0.6 (0-10). No cancer-related events occurred during follow-up. Late complications (4%) were not related to the surgical approach. CONCLUSIONS Umbilical KeyPort surgery is technically feasible for a great variety of procedures, both ablative and reconstructive. This access offers adequate surgical outcomes, scarce postoperative pain and security for the patient in the short term. Its reusable nature implies a noticeable economic advantage.
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Affiliation(s)
- Ana García-Tello
- Department of Urology, Hospital Universitario de Getafe, Fundación para la Investigación Biomédica, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid , Madrid , Spain
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Kishore T, Shetty A, Balan T, John MM, Iqbal M, Jose J, Vinodan K. Laparoscopic Donor Nephrectomy with Transvaginal Extraction: Initial Experience of 30 Cases. J Endourol 2013; 27:1361-5. [DOI: 10.1089/end.2013.0412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T.A. Kishore
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Abijit Shetty
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Tarun Balan
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Mammen M. John
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Mohammed Iqbal
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Joshy Jose
- Department of Anesthesiology, Medical Trust Hospital, Cochin, Kerala, India
| | - K. Vinodan
- Department of Anesthesiology, Medical Trust Hospital, Cochin, Kerala, India
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Qadan M, Curet MJ, Wren SM. The evolving application of single-port robotic surgery in general surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:26-33. [DOI: 10.1002/jhbp.37] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Motaz Qadan
- Department of Surgery; Stanford University Medical Center; Palo Alto CA USA
| | | | - Sherry M. Wren
- Department of Surgery; Stanford University Medical Center; Palo Alto CA USA
- Department of Surgery; Veterans Affairs Palo Alto Health Care System; 3801 Miranda Avenue Palo Alto CA 94304 USA
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Schwentner C, Todenhöfer T, Seibold J, Alloussi S, Aufderklamm S, Mischinger J, Stenzl A, Gakis G. Cost effective laparoendoscopic single-site surgery with a reusable platform. JSLS 2013; 17:285-91. [PMID: 23925023 PMCID: PMC3771796 DOI: 10.4293/108680813x13654754534477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The authors found that laparoendoscopic single-site surgery with a reusable platform was feasible for various urologic entities, yielding favorable cosmetic and functional results. Background and Objectives: Many disposable platforms have been applied in laparoendoscopic single-site surgery (LESS). Besides technical issues, cost is one of the limiting factors for its widespread acceptance. The current study describes the first completely reusable LESS-platform. Methods: We performed LESS-procedures in 52 patients including nephrectomy (18), adrenalectomy (2), partial nephrectomy (3), pyeloplasty (4), renal cyst ablation (4), pelvic lymphadenectomy (15), and lymphocele ablation (6). All procedures were conducted using a novel reusable single-port device (X-Cone, Karl-Storz) with a simplified set of instruments. We obtained perioperative and demographic data, including a visual analogue pain scale (VAS), and a complication reporting system based on Clavien grading. Results: Mean age was 50.04 y. Conversion to standard laparoscopy was necessary in 3 cases and addition of a needlescopic instrument in 6 cases. There was no open conversion. Intra- and postoperative complications occurred in 3 (Clavien II in 2 and III in 1) cases. Mean operative time was 110, 90, and 89 min, and hospital stay was 4.9, 3.1, and 3.6 d for nephrectomy, pelvic lymphadenectomy, and pyeloplasty, respectively. Mean VAS was 2.13, 1.07, and 1.5 while blood loss was 81.3 mL, 25.67 mL, and 17.5 mL, respectively. Mean lymph node yield was 15 (range, 8 to 21). Conclusions: A completely reusable LESS-platform is applicable to various uses in urology, yielding favorable functional and cosmetic results. Reusable materials are useful to reduce the cost of LESS, further increasing its acceptance. LESS with a completely reusable platform is more cost effective than standard laparoscopy.
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Affiliation(s)
- C Schwentner
- Department of Urology, Eberhard-Karls University Tuebingen, Germany.
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Richstone L, Rais-Bahrami S, Waingankar N, Hillelsohn JH, Andonian S, Schwartz MJ, Kavoussi LR. Pfannenstiel laparoendoscopic single-site (LESS) vs conventional multiport laparoscopic live donor nephrectomy: a prospective randomized controlled trial. BJU Int 2013; 112:616-22. [DOI: 10.1111/bju.12202] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Lee Richstone
- Arthur Smith Institute for Urology; Hofstra North Shore-LIJ School of Medicine; New Hyde Park NY USA
| | - Soroush Rais-Bahrami
- Arthur Smith Institute for Urology; Hofstra North Shore-LIJ School of Medicine; New Hyde Park NY USA
| | - Nikhil Waingankar
- Arthur Smith Institute for Urology; Hofstra North Shore-LIJ School of Medicine; New Hyde Park NY USA
| | - Joel H. Hillelsohn
- Arthur Smith Institute for Urology; Hofstra North Shore-LIJ School of Medicine; New Hyde Park NY USA
| | - Sero Andonian
- Arthur Smith Institute for Urology; Hofstra North Shore-LIJ School of Medicine; New Hyde Park NY USA
| | - Michael J. Schwartz
- Arthur Smith Institute for Urology; Hofstra North Shore-LIJ School of Medicine; New Hyde Park NY USA
| | - Louis R. Kavoussi
- Arthur Smith Institute for Urology; Hofstra North Shore-LIJ School of Medicine; New Hyde Park NY USA
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Shi L, Cai W, Dong J, Zhang X, Gao J, Song T, Sun S, Zu Q, Wang W. Single-port laparoscopic retroperitoneal surgery using a modified single-port device in urology. Urol Int 2013; 92:83-8. [PMID: 23817217 DOI: 10.1159/000350937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/25/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the use of a flexible instrument platform in performing single-port laparoscopic retroperitoneal urologic surgeries and to verify the safety and feasibility of these surgeries. METHODS The homemade instrument platform consisted of two control loops and a powder-free surgical glove to form multichannels. 56 patients underwent this kind of single-port surgery for different urologic diseases, including radical nephrectomy in 31 patients, nephroureterectomy in 7 patients, partial nephrectomy in 8 patients, living donor nephrectomy in 4 patients, adrenalectomy in 3 patients, renal cyst surgery in 2 patients and ureterolithotomy in 1 patient. RESULTS All surgeries were completed successfully with no switch to conventional laparoscopic or open surgery. The mean hospital stay was 13.13 days (range 6-36). All patients were satisfied without major complications. CONCLUSIONS Retroperitoneal laparoendoscopic single-site surgery using our cost-effective homemade instrument platform appears to be a feasible and safe surgical strategy to perform retroperitoneal laparoscopic urologic surgery.
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Affiliation(s)
- Lixin Shi
- Department of Urology, China People's Liberation Army General Hospital, Beijing, PR China
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Safe initiation of a laparoendoscopic single site living donor nephrectomy program in a small-volume transplant center. Urology 2013; 82:352-7. [PMID: 23726165 DOI: 10.1016/j.urology.2013.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/13/2013] [Accepted: 03/22/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe keys to successful programmatic implementation of laparoendoscopic single-site (LESS)-living donor nephrectomy (LDN) in a small-volume center. Laparoscopic LDN has become the standard of care. Technically challenging LESS-LDN has been limited to high-volume centers. However, approximately half of all U.S. transplant centers perform ≤15 LDNs/year, including our center. METHODS A hand-assisted laparoscopy (HAL) device was used as the LESS platform at a periumbilical midline incision. We used an adhesive drape to cover the platform to prevent gas leakage. A 30° telescope and 3-4 instruments were inserted through its gel-cap. After careful dissection, the kidney was bagged into a recovery device with an external handle before its vessels were ligated with staples and was then removed immediately through the LESS wound. RESULTS LESS-LDN was successful in all of 10 living donors without any multisite laparoscopic or open conversion and without any instruments inserted through extra wounds. No patient had perioperative complications or received transfusions. Median operative time was 271 minutes with a warm ischemia time (WIT) of 3.5 minutes. Hospital stay averaged 2 days with visual analog pain score 4 of 10 at discharge and 2 of 10 at 2 weeks. All recipients recuperated well with immediate graft function. CONCLUSION Our LESS-LDN technique offers improved cosmesis, favorable perioperative outcomes, and versatile options for conversion, if necessary, making it a viable approach for small-volume centers.
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McCrory B, Lowndes BR, LaGrange CA, Miller EE, Hallbeck MS. Comparative usability testing of conventional and single incision laparoscopic surgery devices. HUMAN FACTORS 2013; 55:619-631. [PMID: 23829035 DOI: 10.1177/0018720812465082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The objective was to perform competitive usability testing to assess the user experience of conventional laparoscopic and laparoendoscopic single-site surgery (LESS) devices. BACKGROUND Recent advancements in single-incision instrumentation have created more interest in and usage of LESS. However, neither LESS nor its novel multichannel access devices have been thoroughly studied. METHOD Using a simulation test bed and standardized laparoscopic surgery task, the user experience of three commercially available LESS devices was compared to conventional laparoscopic ports based on time on task, errors, task success, and perceived ease of use. RESULTS There were no significant differences between devices for time on task, errors, or task success (p > .05). For all devices, there were significantly more recoverable than unrecoverable errors, and errors occurred more frequently during the second phase of the task when the dominant hand was more active (p < .0001). Conventional laparoscopy was rated as easier to use than were the LESS devices (p < .01). CONCLUSION Device performance of a basic laparoscopic task was similar in both conventional laparoscopy and LESS. Each of the LESS devices facilitated efficient and accurate aiming and grasping movements compared to conventional laparoscopy. Further investigation of human factors and ergonomics of LESS is needed to further develop, evaluate, and refine single-site surgery technologies to create a user experience equivalent to conventional laparoscopy. APPLICATION Competitive usability testing of medical devices yields objective performance data that can be used to inform purchase decisions and future device design improvements.
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Affiliation(s)
- Bernadette McCrory
- Department of Biomedical Engineering, University of Nebraska-Lincoln, 342 Nebraska Hall, Lincoln, NE 68588-0526, USA.
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Abdel-Karim AM, Elmissiry M, Aboulfotoh A, Moussa A, Elsalmy S. Laparoendoscopic single-site surgery (LESS) and conventional laparoscopic extravesical repair of vesicouterine fistula: single-center experience. Int Urol Nephrol 2013; 45:995-1000. [DOI: 10.1007/s11255-013-0467-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
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Hu Q, Gou Y, Sun C, Xu K, Xia G, Ding Q. A systematic review and meta-analysis of current evidence comparing laparoendoscopic single-site adrenalectomy and conventional laparoscopic adrenalectomy. J Endourol 2013; 27:676-83. [PMID: 23391020 DOI: 10.1089/end.2012.0687] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess the efficacy and safety of laparoendoscopic single-site adrenalectomy (LESS-A) and conventional laparoscopic adrenalectomy (LA) as a systematic review and meta-analysis of current evidence. METHODS We conducted a thorough search for comparative studies that compared LESS-A and conventional LA in the following databases: MEDLINE, EMBASE, and the Cochrane library. Studies were reviewed independently and rated by Newcastle-Ottawa Quality Assessment Scale. The operative time, estimated blood loss in operation, the time to resume oral intake after surgery, postoperative hospital stay, and the visual analog pain scale (VAPS) score were included for analysis to compare the efficacy, while the complications together with the analgesia use were included for analysis to compare the safety. RESULTS Nine studies with 171 LESS-A cases and 272 conventional LA cases were identified. Although operative time was longer in LESS-A (mean difference [MD] 15.46, 95% confidence interval [CI] 11.18 to 19.74), estimated blood loss (MD 4.72, 95% CI 12.08 to 21.52) and the time to resume oral intake (MD -0.04, 95% CI -0.19 to 0.11) were similar; LESS-A presented a shorter postoperative stay in hospital (MD -0.60, 95% CI -0.86 to -0.35) and lower VAPS score (MD -1.21, 95% CI -1.44 to -0.97). Besides, the risk of minor postoperative complications (risk ratio [RR] 1.74, 95% CI 0.78 to 3.87) was similar. The postoperative analgesia demand in total (RR 0.65, 95% CI 0.52 to 0.81) together with the analgesia usage lasting more than 24 hours after surgery (RR 0.35, 95% CI 0.21 to 0.58) were associated with lower risk in LESS-A, however. CONCLUSIONS Based on current evidence, the operative time seems to be longer in LESS-A; however, operative blood loss and complications are similar. In addition, LESS-A presents a shorter hospital stay after surgery and more acceptable perception of pain than conventional LA.
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Affiliation(s)
- Qingfeng Hu
- Department of Urology and Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
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Nefrectomia Radicale Laparoendoscopic Single-site (LESS) nel Tumore Renale: Tecnica e Risultati Chirurgici Cosmetici e Valutazione del Dolore Postoperatorio. Urologia 2013. [DOI: 10.5301/urologia.50000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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71
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Stamatakis L, Mercado MA, Choi JM, Sanchez EJ, Gaber AO, Knight RJ, Mayer WA, Link RE. Comparison of laparoendoscopic single site (LESS) and conventional laparoscopic donor nephrectomy at a single institution. BJU Int 2013; 112:198-206. [DOI: 10.1111/j.1464-410x.2012.11763.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Judy M. Choi
- Scott Department of Urology; Baylor College of Medicine
| | | | - A. Osama Gaber
- J. C. Walter Jr. Transplant Center; The Methodist Hospital; Houston; TX; USA
| | - Richard J. Knight
- J. C. Walter Jr. Transplant Center; The Methodist Hospital; Houston; TX; USA
| | - Wesley A. Mayer
- Department of Urology; The Methodist Hospital; Houston; TX; USA
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Tugcu V, Ilbey YO, Sonmezay E, Aras B, Tasci AI. Laparoendoscopic single-site versus conventional transperitoneal laparoscopic pyeloplasty: a prospective randomized study. Int J Urol 2013; 20:1112-7. [PMID: 23441754 DOI: 10.1111/iju.12126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the potential benefits of laparoendoscopic single-site pyeloplasty over conventional laparoscopic pyeloplasty. METHODS Between October 2009 and January 2012, 39 patients were enrolled in a prospective study and randomized to undergo a laparoendoscopic single-site pyeloplasty (n = 19) or conventional laparoscopic pyeloplasty (n = 20). The outcomes in the two groups were compared by using Mann-Whitney U-test and χ(2) -test, and considering a P-value less than 0.05 as statistically significant. RESULTS There was no difference in blood loss (55.67 ± 6.71 vs 45.84 ± 5.22 mL, P = 0.60), transfusion rates (0% for both) and hospitalization time (2.12 ± 0.23 vs 2.06 ± 0.34 days, P = 0.72) between the laparoendoscopic single-site pyeloplasty and conventional laparoscopic pyeloplasty groups. The time to return to normal activities was shorter (8.65 ± 1.25 vs 11.53 ± 1.28 days, P = 0.01), and median operative time (195.21 ± 12.15 vs 145.62 ± 15.34 min, P = 0.001) was longer in the laparoendoscopic single-site pyeloplasty group compared with the conventional laparoscopic pyeloplasty group. No significant intraoperative or postoperative complications occurred in either group. Compared with conventional laparoscopic pyeloplasty, laparoendoscopic single-site pyeloplasty yielded better cosmetic results and patient satisfaction. The mean follow-up period was 19.7 months (4-28 months). The success rate was 95% in both the groups. Both the visual analog scale and the postoperative use of analgesics were significantly lower in patients who underwent laparoendoscopic single-site pyeloplasty. CONCLUSIONS Our findings suggest that laparoendoscopic single-site pyeloplasty can offer faster recovery and higher patient satisfaction than conventional laparoscopic pyeloplasty. Thus, this novel technique promises to become the treatment of choice in minimally-invasive management of ureteropelvic junction obstruction.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Cho HJ, Choi YS, Bae WJ, Bae JH, Hong SH, Lee JY, Kim SW, Hwang TK, Cho YH. Another option for laparoscopic living donor nephrectomy: a single center experience comparing two-port versus hand-assisted technique. J Endourol 2013; 27:587-91. [PMID: 23228097 DOI: 10.1089/end.2012.0577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of two-port laparoscopic donor nephrectomy (TPLDN) vs hand-assisted laparoscopic donor nephrectomy (HALDN). PATIENTS AND METHODS Between November 2010 and March 2012, 100 kidney donors scheduled for left nephrectomy were alternatively assigned to HALDN or TPLDN in a 1:1 fashion. All procedures were performed by the same laparoscopic surgeon. Demographic data and intraoperative and early postoperative data were collected prospectively and analyzed. RESULTS There was no difference in the operating time (133±12 vs 142±17 min, P=0.07), blood loss (55±46 vs 58±52 mL, P=0.84), complication rate (10% vs 12%, P=0.74), and length of hospital stay (3.8±0.8 vs 4.1±2.8 days, P=0.5) between the HALDN and TPLDN groups. The warm ischemia time was longer in the TPLDN group (2.2±0.7 vs 3.5±0.9 min, P<0.001). No statistically significant differences were found in the analgesic requirement and the visual analog pain scores. There was a trend toward quicker return to 100% recovery in the TPLDN group (60±46 vs 39±15 days, P=0.05). The TPLDN group had a significantly smaller surgical incision (8.2±0.6 vs 5.5±0.4 cm, P<0.001) and higher scar satisfaction score (7.8±1.5 vs 8.6±1.3, P=0.02) than the HALDN group. No differences were found in the recipient serum creatinine values or in the incidence of delayed graft function. CONCLUSIONS In comparing TPLDN and HALDN, there was no significant difference in a majority of the operative and postoperative parameters. TPLDN might be associated with smaller surgical incision, improved cosmetic satisfaction, and equivalent recipient graft function.
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Affiliation(s)
- Hyuk Jin Cho
- Department of Urology, College of Medicine, Catholic University of Korea, Seoul, Korea
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74
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Inoue T, Tsuchiya N, Narita S, Saito M, Maita S, Numakura K, Obara T, Tsuruta H, Horikawa Y, Satoh S, Habuchi T. Laparoendoscopic Single-site Plus One Trocar Donor Nephrectomy Using the GelPort: Initial Clinical Experience. Urology 2013; 81:308-12. [DOI: 10.1016/j.urology.2012.09.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/06/2012] [Accepted: 09/10/2012] [Indexed: 12/01/2022]
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Abstract
Living kidney donation is on the rise, either due to cultural or ethical reasons or due to a lack of deceased donor kidneys. For adequately counseling of a potential living kidney donor, medical professionals must know not only the immediate risks of kidney donation but also possible long-term effects of kidney donation on the donor's physical and psychological well-being. This also includes a range of aspects such as quality of life, insurance issues, and family planning following kidney donation. This review article is based on a Medline and PubMed search and elucidates the risks living kidney donors face with regard to all aspects just mentioned. Living kidney donation does not end with the operative procedure--long-term cost-free physical and psychological follow-up should be offered to each donor for the gift he or she is willing to give to the recipient.
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Affiliation(s)
- M Giessing
- Department of Urology, Heinrich Heine University Hospital, Duesseldorf, Germany.
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Yang TX, Chua TC. Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. Int J Colorectal Dis 2013; 28:89-101. [PMID: 22828958 DOI: 10.1007/s00384-012-1537-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC). BACKGROUND Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published. METHODS A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested. RESULTS Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD) = -0.68; 95 % CI = -1.20 to -0.16; p = 0.0099), shorter incision length (pooled WMD = -1.37; 95 % CI = -2.74 to 0.000199; p = 0.05), less estimated blood loss (pooled WMD = -20.25; 95 % CI = -39.25 to -1.24; p = 0.037), and more lymph nodes harvested (pooled WMD = 1.75; 95 % CI = 0.12 to 3.38; p = 0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio = 0.83; 95 % CI = 0.57 to 1.20; p = 0.33) or operative time (pooled WMD = 5.06; 95 % CI = -2.91 to 13.03; p = 0.21). CONCLUSION SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other.
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Affiliation(s)
- Timothy X Yang
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, NSW 2217, Australia
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Springer C, Inferrera A, Kawan F, Schumann A, Fornara P, Greco F. Laparoendoscopic single-site versus conventional laparoscopic radical nephrectomy for renal cell cancer in patients with increased comorbidities and previous abdominal surgery: preliminary results of a single-centre retrospective study. World J Urol 2012; 31:213-8. [DOI: 10.1007/s00345-012-1005-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/30/2012] [Indexed: 12/18/2022] Open
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Two-port Laparoscopic Donor Nephrectomy With Simple Retraction Technique. Urology 2012; 80:1379-82. [DOI: 10.1016/j.urology.2012.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/06/2012] [Accepted: 08/17/2012] [Indexed: 11/23/2022]
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Safety Study of Umbilical Single-port Laparoscopic Radical Prostatectomy with a New DuoRotate System. Eur Urol 2012; 62:1143-9. [DOI: 10.1016/j.eururo.2012.04.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 04/22/2012] [Indexed: 01/18/2023]
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80
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Chern BSM, Lakhotia S, Khoo CK, Siow AYM. Single incision laparoscopic surgery in gynecology: Evolution, current trends, and future perspectives. Gynecol Minim Invasive Ther 2012. [DOI: 10.1016/j.gmit.2012.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Schwentner C, Todenhöfer T, Seibold J, Alloussi SH, Aufderklamm S, Mischinger J, Germann M, Stenzl A, Gakis G. Upper urinary tract laparoendoscopic single-site surgery based on a novel cost-effective reusable platform. J Endourol 2012; 27:202-7. [PMID: 22913756 DOI: 10.1089/end.2012.0409] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Several disposable platforms have been introduced for laparoendoscopic single-site (LESS) surgery. Besides technical issues, cost is one of the main limiting factors for their widespread use. We present our experience with LESS surgery for kidney pathologies using the first completely reusable LESS platform. PATIENTS AND METHODS We performed LESS kidney procedures in 29 patients including nephrectomy (18), partial nephrectomy (3), pyeloplasty (4), and renal cyst ablation (4). All procedures were performed using a completely reusable single-port device (X-Cone) with a simplified combination of standard and prebent instruments. We obtained perioperative and demographic data including a visual analog pain scale (VAS); complications were recorded using Clavien grading. RESULTS Mean patient age was 49.31 years. Conversion to standard laparoscopy was necessary in one and addition of a needlescopic instrument in four cases. No open conversion was necessary. Intra- and postoperative complications occurred in two (Clavien II) cases. Mean operative time was 110, 90, and 89 minutes, and hospital stay was 4.9, 3.1, and 3.6 days for nephrectomy, partial nephrectomy, and pyeloplasty, respectively. Mean VAS was 2.13, 1.67, and 1.5 while blood loss was 81.3 mL, 140 mL, and 17.5 mL, respectively. There were no positive resection margins. CONCLUSIONS LESS with a completely reusable platform is feasible for different upper urinary tract procedures yielding favorable functional and cosmetic results. A simplified combination of standard straight instruments and a single prebent grasper facilitates handling and shortens the learning curve. Reusable materials significantly reduce cost and may help to further adopt LESS surgery in surgical practice.
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Kaouk JH, Autorino R. Laparoendoscopic Single-site Surgery (LESS) and Nephrectomy: Current Evidence and Future Perspectives. Eur Urol 2012; 62:613-5; discussion 615-6. [DOI: 10.1016/j.eururo.2012.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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83
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Schwentner C, Todenhöfer T, Seibold J, Alloussi S, Germann M, Aufderklamm S, Mischinger J, Stenzl A, Gakis G. [Laparoendoscopic single-site surgery in urology using reusable systems]. Urologe A 2012; 52:54-9. [PMID: 22996422 DOI: 10.1007/s00120-012-3007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Many disposable platforms have been available for laparoendoscopic single-site surgery (LESS) for a long time. Besides technical challenges cost remains the limiting factor for the widespread use of LESS. We present our experiences with the first completely reusable LESS platform. METHODS We performed LESS procedures in 52 patients, including nephrectomy (n=18), adrenalectomy (2), partial nephrectomy (3), pyeloplasty (4), renal cyst ablation (4), pelvic lymphadenectomy (15) and lymphocele ablation (6). All procedures were carried out using a novel reusable single-port device (X-ConeR, Karl-Storz) with a simplified combination of standard and preformed instruments. Perioperative and demographic data including a visual analogue pain scale (VAS) were obtained. Complications were recorded using the Clavien classification. RESULTS The mean age of the patients was 50.04 years. Conversion to standard laparoscopy was necessary in 3 cases and the additional use of a 3 mm needle instrument in 6 cases. There were no open conversions. Intraoperative and postoperative complications occurred in 3 (Clavien II in 2 and III in 1) cases. Mean operating time was 110, 90, and 89 min and hospital stay was 4.9, 3.1 and 3.6 days for nephrectomy, pelvic lymphadenectomy, and pyeloplasty, respectively. The mean VAS was 2.13, 1.07 and 1.5 while blood loss was 81.3 ml, 25.67 ml and 17.5 ml, respectively. CONCLUSIONS The LESS technique with a completely reusable platform is applicable to various indications in urology yielding favorable functional and cosmetic results. This novel simplified combination of instruments facilitates handling and shortens the learning curve. Reusable materials may help to reduce cost leading to a wider acceptance of LESS.
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Affiliation(s)
- C Schwentner
- Klinik für Urologie, Eberhard-Karls-Universität, Tübingen.
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Rosoff JS, Fine RG, Velez MC, Del Pizzo JJ. Laparoendoscopic single-site radical nephrectomy for large renal masses. J Endourol 2012; 27:34-9. [PMID: 22984849 DOI: 10.1089/end.2012.0115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report our operative experience and short-term outcomes for the laparoendoscopic single-site (LESS) management of large renal tumors and tumors of advanced stage. PATIENTS AND METHODS Ten consecutive patients underwent LESS-radical nephrectomy (RN) for large (≥ 7 cm) and/or locally advanced tumors (>T(2)). Intraoperative, postoperative, and short-term follow-up data were analyzed. RESULTS Median surgical time was 146 minutes (range 73-164 min), and median estimated blood loss was 100 mL (range 25-400 mL). No procedure needed conversion to open RN or hand-assisted laparoscopic RN. The median hospital stay was 47 hours (range 42 hours-12 days). One (10%) patient had a minor complication (postoperative fever treated with antibiotics) and one (10%) patient had a major complication (small bowel obstruction necessitating reoperation). Of the 10 tumors, 2 were pathologic stage T(1b), 4 were pathologic stage T(2), and 4 were stage T(3a). At a median follow-up of 12.3 months (range 1-16 mos), six (60%) patients were alive without evidence of recurrence, and 4 (40%) patients were alive with disease. Of those four patients, all four had known metastatic disease before surgery. CONCLUSION LESS-RN for large or advanced stage renal masses is a technically challenging operation. In experienced hands, however, it is a safe and feasible therapeutic option for the management of these tumors.
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Affiliation(s)
- James S Rosoff
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
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Bazzi WM, Stroup SP, Kopp RP, Cohen SA, Sakamoto K, Derweesh IH. Comparison of laparoendoscopic single-site and multiport laparoscopic radical and partial nephrectomy: a prospective, nonrandomized study. Urology 2012; 80:1039-45. [PMID: 22990064 DOI: 10.1016/j.urology.2012.07.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/31/2012] [Accepted: 07/11/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To prospectively compare outcomes of laparoendoscopic single-site and multiport laparoscopic radical nephrectomy and partial nephrectomy, focusing on postoperative pain and analgesic requirement. METHODS Nonrandomized, prospective comparison of laparoendoscopic single-site and multiport laparoscopic radical nephrectomy and partial nephrectomy. Thirty-four patients underwent laparoendoscopic single-site (17 radical nephrectomy/17 partial nephrectomy); 42 underwent multiport laparoscopy (28 radical nephrectomy/14 partial nephrectomy) from February 2009 to February 2010. Laparoendoscopic single-site transperitoneal access was obtained by periumbilical incision through which all trocars were inserted. Laparoendoscopic radical nephrectomy/partial nephrectomy recapitulated steps of multiport laparoscopic radical nephrectomy/partial nephrectomy. Demographics/tumor characteristics, outcomes, and complications were analyzed. RESULTS Forty-two of 42 multiport laparoscopic and 32/34 laparoendoscopic single-site cases were successfully performed. Mean follow-up was 16.2 months. For laparoendoscopic single-site and multiport laparoscopy groups mean operating room time (min) was 159.3 vs 158.9 (P = .952); mean estimated blood loss (mL) was 175.7 vs 156.1 (P = .553); percent transfused was 2.9% vs 0% (P = .925). No significant differences in complications were noted (P = .745). Significant decrease in analgesic use (6 morphine equivalents vs 11.6, P < .001) and discharge pain score (1.7 vs 2.7, P < .01) were noted in laparoendoscopic single-site vs multiport laparoscopic radical nephrectomy. For laparoendoscopic single-site partial nephrectomy and multiport laparoscopic partial nephrectomy, no significant differences were noted for tumor diameter (1.8 vs 2.0 cm, P = .57), RENAL score (0.962), ischemia time (28.6 vs 27.5 minutes, P = .70), and preoperative (P = .78)/postoperative creatinine (P = .32). For laparoendoscopic single-site radical nephrectomy and multiport laparoscopic radical nephrectomy, no significant differences were noted for mean tumor diameter (5.6 vs 5.3 cm, P = .63), RENAL score (P = .815), and mean operative time (142.3 vs 155.4 minutes P = .13). CONCLUSION In this well-matched, prospective comparison, laparoendoscopic single-site is comparable with multiport laparoscopic surgery in terms of perioperative parameters and may confer benefit with respect to analgesic requirement. Randomized evaluation and longer-term follow-up are necessary.
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Affiliation(s)
- Wassim M Bazzi
- Department of Surgery/Division of Urology, University of California, San Diego School of Medicine, La Jolla, CA 90293-0987, USA
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Autorino R, Kaouk JH, Stolzenburg JU, Gill IS, Mottrie A, Tewari A, Cadeddu JA. Current status and future directions of robotic single-site surgery: a systematic review. Eur Urol 2012; 63:266-80. [PMID: 22940173 DOI: 10.1016/j.eururo.2012.08.028] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/15/2012] [Indexed: 12/22/2022]
Abstract
CONTEXT Despite the increasing interest in laparoendoscopic single-site surgery (LESS) worldwide, the actual role of this novel approach in the field of minimally invasive urologic surgery remains to be determined. It has been postulated that robotic technology could be applied to LESS to overcome the current constraints. OBJECTIVE To summarize and critically analyze the available evidence on the current status and future of robotic applications in single-site surgery. EVIDENCE ACQUISITION A systematic literature review was performed in April 2011 using PubMed and the Thomson-Reuters Web of Science. In the free-text protocol, the following terms were applied: robotic single site surgery, robotic single port surgery, robotic single incision surgery, and robotic laparoendoscopic single site surgery. Review articles, editorials, commentaries, and letters to the editor were included only if deemed to contain relevant information. In addition, cited references from the selected articles and from review articles retrieved in the search were assessed for significant manuscripts not previously included. The authors selected 55 articles according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. EVIDENCE SYNTHESIS The volume of available clinical outcomes of robotic LESS (R-LESS) has considerably grown since the pioneering description of the first successful clinical series of single-port robotic procedures. So far, a cumulative number of roughly 150 robotic urologic LESS cases have been reported by different institutions across the globe with a variety of techniques and port configurations. The feasibility of robot-assisted single-incision colorectal procedures, as well as of many gynecologic procedures, has also been demonstrated. A novel set of single-site instruments specifically dedicated to LESS is now commercially available for use with the da Vinci Si surgical system, and both experimental and clinical use have been reported. However, the current robotic systems were specifically designed for LESS. The ideal robotic platform should have a low external profile, the possibility of being deployed through a single access site, and the possibility of restoring intra-abdominal triangulation while maintaining the maximum degree of freedom for precise maneuvers and strength for reliable traction. Several purpose-built robotic prototypes for single-port surgery are being tested. CONCLUSIONS Significant advances have been achieved in the field of R-LESS since the first reported clinical series in 2009. Given the several advantages offered by current the da Vinci system, it is likely that its adoption in this field will increase. The recent introduction of purpose-built instrumentation is likely to further foster the application of robotics to LESS. However, we are still far from the ideal robotic platform. Significant improvements are needed before this technique might reach widespread adoption beyond selected centers. Further advances in the field of robotic technology are expected to provide the optimal interface to facilitate LESS.
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Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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87
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Yang TX, Chua TC. Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. Int J Colorectal Dis 2012. [PMID: 22828958 DOI: 10.1007/s00384-012-1537-0.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVE This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC). BACKGROUND Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published. METHODS A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested. RESULTS Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD) = -0.68; 95 % CI = -1.20 to -0.16; p = 0.0099), shorter incision length (pooled WMD = -1.37; 95 % CI = -2.74 to 0.000199; p = 0.05), less estimated blood loss (pooled WMD = -20.25; 95 % CI = -39.25 to -1.24; p = 0.037), and more lymph nodes harvested (pooled WMD = 1.75; 95 % CI = 0.12 to 3.38; p = 0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio = 0.83; 95 % CI = 0.57 to 1.20; p = 0.33) or operative time (pooled WMD = 5.06; 95 % CI = -2.91 to 13.03; p = 0.21). CONCLUSION SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other.
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Affiliation(s)
- Timothy X Yang
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, NSW 2217, Australia
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88
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Oh TH. Current status of laparoendoscopic single-site surgery in urologic surgery. Korean J Urol 2012; 53:443-50. [PMID: 22866213 PMCID: PMC3406188 DOI: 10.4111/kju.2012.53.7.443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/08/2012] [Indexed: 01/14/2023] Open
Abstract
Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. Laparoendoscopic single-site surgery (LESS) potentially takes this further. Following the first human urological LESS report in 2007, numerous case series have emerged, as well as comparative studies comparing LESS with standard laparoscopy. However, comparative series between conventional laparoscopy and LESS for different procedures suggest a non-inferiority of LESS over standard laparoscopy, but the only objective benefit remains an improved cosmetic outcome. Challenging ergonomics, instrument clashing, lack of true triangulation, and in-line vision are the main concerns with LESS surgery. Various new instruments have been designed, but only experienced laparoscopists and well-selected patients are pivotal for a successful LESS procedure. Robotic-assisted LESS procedures have been performed. The available robotic platform remains bulky, but development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.
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Affiliation(s)
- Tae Hee Oh
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Evolution and simplified terminology of natural orifice transluminal endoscopic surgery (NOTES), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). World J Urol 2012; 30:573-80. [PMID: 22790450 DOI: 10.1007/s00345-012-0899-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/19/2012] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) are the next steps in the evolution of laparoscopic surgery, promising reduced morbidity and improved cosmetic result. The inconsistent terminology initially used led to confusion. Understanding the technical evolution, the current status and a unified and simplified terminology are key issues for further acceptance of both approaches. OBJECTIVE To present LESS and NOTES in its historical context and to clarify the associated terminology. METHOD Extensive literature search took place using the PubMed. Several hundred publications in general surgery and urology regarding LESS are present including the expert opinion of members the European Society of Uro-technology (ESUT). RESULTS The increasing interest on NOTES and LESS is reflected by a raising number of publications during the last 4 years. The initial confusion with the terminology of single-incision surgery represented a significant issue for further evolution of the technique. Thus, consortiums of experts searched a universally acceptable name for single-incision surgery. They determined that 'laparoendoscopic single-site surgery' (LESS) was both scientifically accurate and colloquially appropriate, the term being also ratified by the NOTES working group (Endourological Society) and the ESUT. For additional use of instruments, the terms hybrid NOTES and hybrid LESS should be used. Any single use of miniaturized instruments for laparoscopy should be called mini-laparoscopy. DISCUSSION The evolution of LESS and most likely NOTES to a new standard of minimally invasive surgery could represent an evolutionary step even greater than the one performed by the establishment of laparoscopy over open surgery.
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Laparoendoscopic Single-Site Radical Nephrectomy for Renal Cancer: Technique and Surgical Outcomes. Eur Urol 2012; 62:168-74. [PMID: 22030118 DOI: 10.1016/j.eururo.2011.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/06/2011] [Indexed: 10/16/2022]
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Balaphas A, Hagen ME, Buchs NC, Pugin F, Volonté F, Inan I, Morel P. Robotic laparoendoscopy single site surgery: a transdisciplinary review. Int J Med Robot 2012; 9:1-11. [DOI: 10.1002/rcs.1445] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 01/27/2023]
Affiliation(s)
- Alexandre Balaphas
- Clinic for Visceral Surgery and Transplantation, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Monika E. Hagen
- Clinic for Visceral Surgery and Transplantation, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Nicolas C. Buchs
- Clinic for Visceral Surgery and Transplantation, Department of Surgery; University Hospital of Geneva; Switzerland
| | - François Pugin
- Clinic for Visceral Surgery and Transplantation, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Francesco Volonté
- Clinic for Visceral Surgery and Transplantation, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Ihsan Inan
- Clinic for Visceral Surgery and Transplantation, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Philippe Morel
- Clinic for Visceral Surgery and Transplantation, Department of Surgery; University Hospital of Geneva; Switzerland
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92
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Rimonda R, Tang B, Brown SI, Cuschieri A. Comparison of endoscopic task performance with crossed versus uncrossed straight and curved instruments through a single port. Surg Endosc 2012; 26:3605-11. [PMID: 22678178 DOI: 10.1007/s00464-012-2379-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 05/07/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite advancing technology for single-incision minimal access surgery, there have been no reports on the optimal operating setup and the instruments for use through a single port. This study therefore aimed to compare task performance in single-port surgery between crossed and uncrossed instruments (straight and distally coaxially curved). METHODS A dedicated trainer box was used to investigate the performance of two tasks (pick-transfer-place and dissection) by 18 surgical residents using two randomly allocated manipulating systems: (1) a conventional, uncrossed manipulation system (UCMS), with surgery through a cone-shaped 40-mm port using coaxially curved or straight instruments subtending a 30° manipulation angle, and (2) a crossed manipulation system (CMS), with surgery through a cylindrical miniport (25 mm) using coaxially curved instruments. RESULTS The pick-transfer-place task performed with the UCMS enabled comparison between straight and curved coaxial instruments and showed that although the participants moved the same number of objects with either type (p = 0.464), they dropped a significantly more objects with straight instruments (1.5 ± 1.33 vs. 0.61 ± 0.85; p = 0.013). The execution of this task with the CMS (curved instruments only) provided a performance (dropped objects and error rates) equal to that obtained by the UCMS with curved instruments (p = 0.521, p = 0.989). The dissection task with the UCMS showed no difference between straight and curved coaxial instruments in dissection accuracy (75.6 vs. 75.5%; p = 0.950) or execution times (258 vs. 302 s; p = 0.367). The performance of this task by the CMS and the UCMS (with curved coaxial instruments) was equivalent with regard to dissection accuracy (p = 0.849) and execution time (p = 0.402). CONCLUSIONS Using the UCMS, task performance is better with distally curved coaxial instruments. The CMS (with curved instruments) gives a task performance equivalent to that obtained with UCMS.
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Affiliation(s)
- Roberto Rimonda
- Centro Universitario di Chirurgia Mini-Invasiva, Molinette Hospital, University of Turin, Turin, Italy
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93
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Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol 2012; 62:601-12. [PMID: 22704730 DOI: 10.1016/j.eururo.2012.05.055] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 05/28/2012] [Indexed: 02/08/2023]
Abstract
CONTEXT Laparoendoscopic single-site (LESS) surgery has increasingly been used to perform radical, partial, simple, or donor nephrectomy to reduce the morbidity and scarring associated with surgical intervention. Studies comparing LESS nephrectomy (LESS-N) and conventional laparoscopic nephrectomy (CL-N) have reported conflicting results. OBJECTIVE To assess the current evidence regarding the efficiency, safety, and potential advantages of LESS-N compared with CL-N. EVIDENCE ACQUISITION We comprehensively searched PubMed, Embase, and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the two techniques. EVIDENCE SYNTHESIS Two RCTs and 25 retrospective studies including a total of 1094 cases were identified. Although LESS-N was associated with a longer operative time (weighted mean difference [WMD]: 9.87 min; 95% confidence interval [CI], 3.37-16.38; p=0.003) and a higher conversion rate (6% compared with 0.3%; odds ratio: 4.83; 95% CI, 1.87-12.45; p=0.001), patients in this group might benefit from less postoperative pain (WMD: -0.48; 95% CI, -0.95 to -0.02; p=0.04), lower analgesic requirement (WMD: -4.78 mg; 95% CI, -8.59 to -0.97; p=0.01), shorter hospital stay (WMD: -0.32 d; 95% CI, -0.55 to -0.09; p=0.007), shorter recovery time (WMD: -5.08 d; 95% CI, -8.49 to -1.68; p=0.003), and better cosmetic outcome (WMD: 1.07; 95% CI, 0.67-1.48; p<0.00001). Perioperative complications, estimated blood loss, warm ischemia time, and postoperative serum creatinine levels of graft recipients did not differ significantly between techniques. CONCLUSIONS LESS-N offers a safe and efficient alternative to CL-N with less pain, shorter recovery time, and better cosmetic outcome. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis.
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94
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Wang L, Liu B, Wu Z, Yang Q, Chen W, Xu Z, Wang C, Xiao L, Wang F, Sun Y. A Matched-Pair Comparison of Laparoendoscopic Single-Site Surgery and Standard Laparoscopic Radical Nephrectomy by a Single Urologist. J Endourol 2012; 26:676-81. [PMID: 22017261 DOI: 10.1089/end.2011.0161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Linhui Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bing Liu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Chen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zunli Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Cheng Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Liang Xiao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fubo Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Galvani CA, Garza U, Leeds M, Kaul A, Echeverria A, Desai CS, Jie T, Diana R, Gruessner RWG. Single-incision robotic-assisted living donor nephrectomy: case report and description of surgical technique. Transpl Int 2012; 25:e89-92. [PMID: 22607520 DOI: 10.1111/j.1432-2277.2012.01493.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The introduction of laparoscopic surgery, and more recently of robotics, has increased the number of living donor kidney transplants. This approach has already improved living donor acceptance rates. Even newer developments in the field have now been introduced with the purpose of further reducing postoperative pain and length of hospital stay, while offering better cosmetic results. In particular, single-incision surgery has gained popularity by improving the well-known benefits of minimally invasive surgery. In this case report, we present the first single-incision robotic-assisted living donor nephrectomy.
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Affiliation(s)
- Carlos A Galvani
- Department of Surgery, University of Arizona, Tucson, AZ 85724, USA.
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96
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Single-port laparascopic cholecystectomy: scarless cholecystectomy. Minim Invasive Surg 2012; 2012:204380. [PMID: 22645675 PMCID: PMC3356709 DOI: 10.1155/2012/204380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/16/2012] [Indexed: 12/13/2022] Open
Abstract
Objective. Single-incision laparoscopic surgery is a new advanced technology to further minimize the invasiveness of laparoscopy through a single small incision hidden in the umbilicus. The objective is to describe short and long-term outcomes of SILS cholecystectomy. Methodology. Patients with gallbladder pathologies were unselectively enrolled and were prospectively studied between April 2009 and April 2010 and completed a post-operative follow-up for 12 months. Results. There were 22 women and 8 men. Mean age was 46 years. Twenty-one patients had biliary colic, seven had acute cholecystitis, one had gallbladder polyp, and another had resolving acute pancreatitis. Mean operative time was 104.3 ± 44 minutes. Mean BMI was 30.42 and the average pain score was 3.2 ± 1.1. One more port was inserted to help in finishing the procedure in one patient. There was no conversion to a standard laparoscopic or open technique. There was one post-operative bile collection from a missed cyctic duct of Luschka. Mean hospital stay was 1.2 days. Conclusion. Single-port laparoscopic cholecystectomy is feasible. Early conversion to a standard laparoscopic technique is advised to avoid serious complications. The procedure has an obvious cosmetic benefit. Additional prospective trials are necessary to define the benefits of single-port laparoscopic cholecystectomy.
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97
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Abstract
A donor would prefer a minimally invasive procedure because of lesser morbidity, this may be the reason that laparoscopic donor nephrectomy (LDN) rates have exponentially increased. The rationale dictates that a virtually scarless surgery would be most beneficial to this patient subgroup. In this article, we review the approach, instrumentation, dissection and retrieval issues and the results of laparoendoscopic single-site donor nephrectomy (LESS-DN). The existing literature on LESS-DN was reviewed in Pubmed. The various access sites described for LESS-DN include the umbilicus and Pfannenstiel incision. The steps of LESS-DN duplicate those of standard LDN. There is a paucity of studies comparing LESS-DN with LDN, particularly randomized studies. The most challenging step of LESS-DN is graft retrieval. Authors have described a variety of methods for graft retrieval which include manual methods, and those using retrieval bags. In the majority of the studies, the graft retrieval time is longer in comparison to standard LDN. However, the graft outcome in recipients is comparable. In this article, we also allude to the complications mentioned in various series. LESS-DN is currently an evolving procedure. The procedure requires a high level of skills in laparoscopic surgery. The choice of access site, access site ports and the type of instruments to be used is a matter of surgeon preference. Although the warm ischemia time in most of the series is longer in LESS-DN, this has not translated into poor recipient outcomes. Further work needs to be done to make the retrieval quick. Current literature from comparative studies with standard LDN suggests that the results in terms of graft outcome are comparable.
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Affiliation(s)
- Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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98
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Abstract
In an effort to increase living donor transplantation while minimizing risk and morbidity, recent advances have been made in surgical technique, kidney paired donation, desensitization, identification of living donors and research into living donor outcomes. Single-port nephrectomy and vaginal extraction have reduced donor nephrectomy incision size. Transport of live donor kidneys has reduced geographic barriers to kidney paired donation, and participation of compatible pairs and nondirected donors has increased match opportunities for incompatible pairs participating in this modality. ABO-incompatible transplantation can now be successfully performed without high-intensity immunomodulation, and HLA-incompatible transplantation has been shown in a large single-center study to provide profound survival benefit compared with waiting for a compatible donor. Complement inhibition is an exciting, emerging approach that may facilitate incompatible transplantation and treat antibody-mediated rejection. Educational and communications interventions are proving valuable in helping patients find living donors, and large studies continue to provide reassurance to carefully screened living donors that risks are very low. As living donors are critical to addressing the profound organ shortage, efforts to increase living donation remain important.
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Affiliation(s)
- Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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99
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Does single-port access (SPA) laparoscopy mean reduced pain? A retrospective cohort analysis between SPA and conventional laparoscopy. Eur J Obstet Gynecol Reprod Biol 2012; 162:71-4. [DOI: 10.1016/j.ejogrb.2012.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 12/01/2011] [Accepted: 01/12/2012] [Indexed: 11/20/2022]
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100
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