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Ates U, Evin E, Ergün E, Serttürk F, İnal D, Khalilova P, Maras H, Göllü G, Kologlu MB, Cakmak AM. Comparison of the results of open repair and laparoscopic repair with the PIRS method in the treatment of hydrocele in children. Pediatr Surg Int 2024; 40:56. [PMID: 38347161 DOI: 10.1007/s00383-024-05632-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE Hydrocele is a result of intraperitoneal fluid filling into the scrotum through the patent processus vaginalis (PPV). While the traditional approach of pediatric hydrocele has been open repair (OR) for years, laparoscopic repair (LR) of hydrocele has been accepted worldwide after the proven efficacy of laparoscopy. The purpose is to compare the outcomes of both techniques in a single center. METHODS We retrospectively analyzed the clinical data of all the patients who underwent hydrocele repair from August 2016 to November 2022. In our center, the standard approach was OR in hydrocele until the November of 2021. Starting from this date, LR has begun to be preferred, as the experience has increased and its success has been observed. In the LR group, single-port percutaneous internal ring suturing technique was performed. RESULTS The data of 113 patients (OR 58.4% (n = 66), LR 41.6% (n = 47)) were collected. In preoperative examination, 12.4% (n = 14) patients were diagnosed as communicating and 87.6% (n = 99) non-communicating hydrocele. Intraoperatively, 65.5% (n = 74) patients were communicating and 34.5% (n = 39) were non-communicating. Total recurrence rate was 7% (n = 8). The OR group experienced a recurrence rate of 10.6% (n = 7), while the LR group experienced 2.12% (n = 1). CONCLUSION Laparoscopy may reveal intrabdominal connection of hydrocele better than open approach. It provides a high quality view of both inguinal rings and has the advantages of minimally invasive surgery.
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Affiliation(s)
- Ufuk Ates
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey.
| | - Ege Evin
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey
| | - Ergun Ergün
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey
| | - Fırat Serttürk
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey
| | - Denizcan İnal
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey
| | - Pari Khalilova
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey
| | - Hatice Maras
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey
| | - Gülnur Göllü
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey
| | | | - Ahmet Murat Cakmak
- Ankara University Medical School, Department of Pediatric Surgery, Ankara, Turkey
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Son TN, Bao HV, Van NTH. Laparoscopic percutaneous closure of patent processus vaginalis without hydrocelectomy for childhood primary hydrocele. Pediatr Surg Int 2023; 39:103. [PMID: 36740654 DOI: 10.1007/s00383-023-05393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE To present our surgical technique and the outcome of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) of patent processus vaginalis (PPV) without hydrocelectomy for childhood primary hydrocele (CPH). METHODS A prospective study was conducted on all cases of CPH treated with SILPEC at our center between June 2016 and December 2021. In our SILPEC procedure, PPV was closed extraperitoneally using a percutaneous needle with a wire lasso. No hydrocelectomy or fenestration of the hydrocele was performed. Percutaneous aspiration was performed when the hydrocele fluid could not be pushed back to the peritoneal cavity. RESULTS 553 patients were enrolled, with a median age of 34 months (range from 22 months to 13 years). Ipsilateral PPV was present in all cases. There were no intraoperative complications and no conversion. At follow-up 6-72 months, recurrent hydrocele occurred in 0.36%, and subcutaneous stitch inflammatory reaction was noted in 0.7%. There was no case of testicular atrophy or iatrogenic cryptorchidism. Postoperative cosmesis was excellent as all patients were virtually scarless. CONCLUSIONS Ipsilateral PPV was present in all cases of CPH in our series. Our technique of SILPEC of PPV without hydrocelectomy is feasible and safe, with excellent postoperative cosmesis in the management of CPH.
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Affiliation(s)
- Tran N Son
- Department of Pediatric Surgery, Saint Paul Hospital, No 12 Chu Van An Street, Ba Dinh District, Hanoi, 100000, Vietnam.
| | - Hoang V Bao
- Department of Pediatric Surgery, Saint Paul Hospital, No 12 Chu Van An Street, Ba Dinh District, Hanoi, 100000, Vietnam
| | - Nguyen T H Van
- Department of Pediatric Surgery, Saint Paul Hospital, No 12 Chu Van An Street, Ba Dinh District, Hanoi, 100000, Vietnam
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Igwe AO, Talabi AO, Adisa AO, Adumah CC, Ogundele IO, Sowande OA, Adejuyigbe O. Comparative Study of Laparoscopic and Open Inguinal Herniotomy in Children in Ile Ife, Nigeria: A Prospective Randomized Trial. J Laparoendosc Adv Surg Tech A 2019; 29:1609-1615. [DOI: 10.1089/lap.2019.0354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Arua Obasi Igwe
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Ademola O. Talabi
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Adewale O. Adisa
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Collins C. Adumah
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Ibukun O. Ogundele
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Oludayo A. Sowande
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Olusanya Adejuyigbe
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
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Jin Z, Wang F. Effectiveness of Laparoscopy in the Treatment of Pediatric Hydrocele: A Systematic Review. J Laparoendosc Adv Surg Tech A 2018; 28:1531-1539. [PMID: 30063415 DOI: 10.1089/lap.2018.0095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To conduct a systematic review of the published studies concerning laparoscopic pediatric hydrocele (PH) repair and summarize the surgical details and operative outcomes of this procedure. Materials and Methods: A PubMed search was performed for all studies concerning laparoscopic repair of hydrocele in children. The search strategy was as follows: (laparoscop* OR coelioscop* OR peritoneoscop* OR laparoendoscop* OR minilaparoscop*) AND hydrocele* AND (child* OR pediatric*). Inclusion criteria included (1) children with hydrocele as the study participant; (2) laparoscopic PH repair as the main surgical procedure; and (3) operation time and complications as the outcomes of interest. Reviews, studies with insufficient information or reporting the outcomes of abdominoscrotal hydrocele, and duplicate patient series were excluded. Results: Overall, 20 studies fulfilled the inclusion criteria of this review and 15 studies were included in the final analysis. These studies comprised at least 2920 patients undergoing laparoscopic repair for various PH subtypes, of which most were conducted in Asia. Most authors repaired PH laparoscopically through an extraperitoneal approach, while only a few studies applied a laparoscopic intraperitoneal method. The majority of the studies used nonabsorbable sutures to ligate hydrocele sac, while very few studies used absorbable materials. Hydrocele sac was resected or transected in only five studies, but left alone in the majority. Mean operation time was between 15.6 and 43.2 minutes for unilateral laparoscopic PH repair and between 16.9 and 53.2 minutes for bilateral surgery. Operative complications were not very common, with a highest recurrence/persistence incidence of 1.4%. Subgroup analysis showed that hydrocele subtype, surgical approach, suture material, and management of hydrocele sac did not significantly influence the operative complications. Conclusions: laparoscopic PH repair seems to be a safe and effective procedure. Given the limitations of this review, our conclusion needs to be confirmed by more well-designed studies.
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Affiliation(s)
- Zhichang Jin
- 1 Department of Urology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Furan Wang
- 2 Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
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Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial. Pediatr Surg Int 2017; 33:367-376. [PMID: 28025693 DOI: 10.1007/s00383-016-4029-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Laparoscopy is being increasingly applied to pediatric inguinal hernia repair. In younger children, however, open repair remains preferred due to concerns related to anesthesia and technical challenges. We sought to assess outcomes after laparoscopic and open inguinal hernia repair in children less than or equal to 3 years. METHODS A prospective, single-blind, parallel group randomized controlled trial was conducted at three clinical sites. Children ≤3 years of age with reducible unilateral or bilateral inguinal hernias were randomized to laparoscopic herniorrhaphy (LH) or open herniorrhaphy (OH). The primary outcome was the number of acetaminophen doses. Secondary outcomes included operative time, complications, and parent/caregiver satisfaction scores. RESULTS Forty-one patients were randomized to unilateral OH (n = 10), unilateral LH (n = 17), bilateral OH (n = 5) and bilateral LH (n = 9). Acetaminophen doses, LOS, complications, and parent/caregiver scores did not differ among groups. Laparoscopic unilateral hernia repair demonstrated shorter operative time, a consistent finding for overall laparoscopic repair in univariate (p = 0.003) and multivariate (p = 0.010) analysis. No cases of testicular atrophy were documented at 2 (SD = 2.7) years. CONCLUSION Children ≤3 years of age in our cohort safely underwent LH with similar pain scores, complications, and recurrence as OH. Parents and caregivers report high satisfaction with both techniques.
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Ibrahim M, Ladan MA, Abdussalam US, Getso KI, Mohammad MA, Chukwuemeka ALJ, Owolabi FL, Akhparov NN, Aipov RR. Open inguinal herniotomy: Analysis of variations. Afr J Paediatr Surg 2015; 12:131-5. [PMID: 26168752 PMCID: PMC4955417 DOI: 10.4103/0189-6725.160361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Repair of congenital groin hernia/hydrocele is the most common surgical procedure performed by paediatric surgeons. There is dearth of literature comparing the outcomes of open herniotomy in children using various surgical approaches. This study was aimed at evaluating the efficacy of open herniotomy by comparing external ring incision, hernial sac twisting and whether or not double ligation has benefit over a single suture application. MATERIALS AND METHODS A multi-centre prospective randomised clinical trial was conducted with a total of 428 patients having congenital inguinal hernia and/or hydrocele. Patients were randomly assigned into four groups: RO (had external ring opened, hernial sac twisted and doubly ligated), ST (had hernial sac twisted and doubly ligated without opening the ring), DL (had double ligation of hernial sac without ring opening nor twisted) while SL (had single ligation of hernial sac with neither ring opening nor sac twisting). RESULTS A total of 458 repairs were done. Patients' age ranged from 0.25 years (3 months) to 21 years in group RO with mean of 4.87 × 4.07 (median, 4), 0.069 years (24 days) to 17 years in group ST with mean of 4.23 × 4.03 (median, 3), 0.5 years (6 months) to 16 years in group DL with mean of 4.59 × 3.87 (median, 4) and 1 year to 19 years in group SL with mean of 5.00 × 4.19 (median, 4). Operation time per repair was 26.50 × 5.46 min, range 16-40 min (median, 27 min) in group RO, 22.18 × 5.34 min, range 12-39 min (median, 21 min) in group ST while 17.98 × 3.40 min with range of 12-39 min (median, 17 min) in group DL and 15.27 × 4.18 min, range 7-40 min (median, 15 min) in group SL P < 0.0001. The mean paracetamol dose/patient was 3.96 × 1.43, 2.94 × 0.81, 2.18 × 0.69, 1.87 × 0.78 in group RO, ST, DL and SL, respectively, P < 0.0001. CONCLUSION Congenital inguinal hernia repair with opening of the external ring, hernia sac twisting and double ligation of the processus vaginalis confers no advantage.
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Affiliation(s)
- Musa Ibrahim
- Department of Surgery, Children Surgical Unit, Murtala Muhammad Specialist Hospital, Kano, Nigeria
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Ibrahim M, Getso KI, Mohammad MA, Akhparov NN, Aipov RR. Herniotomy in resource-scarce environment: Comparison of incisions and techniques. Afr J Paediatr Surg 2015; 12:45-50. [PMID: 25659550 PMCID: PMC4955508 DOI: 10.4103/0189-6725.150980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are various methods for surgical treatment of hernia and hydrocele in children with variable cost-effectiveness, recovery and cosmetic outcomes. This study analyses our experience with mini-incision/invasive herniotomy in children in resource-limited centre. MATERIALS AND METHODS Seven hundred and eighty-four n = 784 patients underwent herniotomy via conventional and mini-invasive methods were assigned into Group A and Group B. Three hundred and seventy-six n = 376 (47.95%) in Group A while four hundred and eight n = 408 (52.04%) in Group B. Eight hundred and seventeen (817) herniotomy was performed. Demographic data, hernia/hydrocele sides, volume of surgical suture used, surgery duration, and complications analysed. RESULTS Right side hernia and/or hydrocele were 464 (59.18%). 287 (36.60%) had left sided while 33 (4.21%) had bilateral hernia and/or hydrocele. There were 14 bilateral hernia repair in Group A and 19 in Group B. The lengths of operation time for unilateral repair ranged from 14 to 54 min in Group A (median, 23 min) and 7-44 min in Group B (median, 15 min) with a mean surgical duration of 15.48 ± 4.16 min in Group B versus 23.41 ± 5.94 min in Group A (P < 0.001) while the range of the lengths of operation time for bilateral repair in Group A was 20-54 min (median, 36) and 12-30 min (median, 21) in Group B with a mean duration of 36.35 ± 9.89 min in Group A versus 20.42 ± 4.83 min in Group B P = 0.00563. 376 sachets of 45 cm suture material were used in Group A versus 137 in Group B. There were total of 87 (23.13%) complications in Group A versus 3 (1.47%) in Group B P = 0.000513. Superficial wound infection and abscess were 9 (2.36%) and 16 (4.25%) in Group A versus none (0) in Group B. CONCLUSION Mini-incision/invasive herniotomy in children and adolescents is fast, cost-effective with satisfactory cosmetic outcome and limited complications.
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Affiliation(s)
- Musa Ibrahim
- Department of Surgery, Murtala Mohammad Specialist Hospital, Children Surgical Unit, Kano, Nigeria
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Saka R, Okuyama H, Sasaki T, Nose S, Yoneyama C, Tsukada R. Laparoscopic treatment of pediatric hydrocele and the evaluation of the internal inguinal ring. J Laparoendosc Adv Surg Tech A 2014; 24:664-8. [PMID: 24959922 DOI: 10.1089/lap.2014.0152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are few reports of the laparoscopic findings of the internal inguinal ring (IIR) in patients with hydrocele. The purpose of this study was to assess the safety and efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) for hydrocele in comparison with that of open repair (OR) and compare the findings of the IIR between cases of hydrocele and inguinal hernia (IH). MATERIALS AND METHODS We analyzed 69 consecutive patients with hydrocele who underwent surgery at our institution between April 2009 and February 2014. The patients were divided into two groups (LPEC and OR) according to the procedure. Age, length of operation/anesthesia, and complications were compared. Concerning the findings of the IIR, we classified the features into three categories, as follows: Type 1, flat; Type 2, narrow patent processus vaginalis (PPV) with a peritoneal veil; and Type 3, widely opened PPV. We then compared these findings between the cases of hydrocele and IH treated with LPEC during the study period. RESULTS Among a total of 69 patients, 40 underwent LPEC, and 29 underwent OR. There were no significant differences in the length of operation/anesthesia and complications. No recurrences were observed in either group. The findings of the IIR were mostly classified as Type 2 (59.1%) among the cases of hydrocele and Type 3 (92%) among the cases of IH. CONCLUSIONS LPEC is a safe and effective procedure for treating hydrocele. The findings of the IIR differ between cases of hydrocele and IH.
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Affiliation(s)
- Ryuta Saka
- Department of Pediatric Surgery, Hyogo College of Medicine , Hyogo, Japan
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Alp BF, Irkilata HC, Kibar Y, Zorba U, Sancaktutar AA, Kaya E, Dayanc M. Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children. Kaohsiung J Med Sci 2013; 30:200-5. [PMID: 24656161 DOI: 10.1016/j.kjms.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/09/2013] [Indexed: 11/19/2022] Open
Abstract
The inguinal approach is used for the treatment of hydrocele in the pediatric population. Although studies on scrotal orchiopexy have mentioned hernia or hydrocele repair through the same scrotal incision as a part of an orchiopexy procedure, there are a few studies reporting the treatment of isolated communicating hydrocele through a scrotal incision. We retrospectively evaluated and compared the outcomes of inguinal and scrotal approaches for the treatment of communicating hydrocele in boys. The classical inguinal and scrotal approaches to the treatment of communicating hydrocele were performed on 46 and 30 testicular units (in 43 boys and 27 boys, respectively). The patients' charts were reviewed to assess the operative times as well as the immediate and long-term complications during follow-up periods. The patients' ages ranged from 1 year to 8 years (3.6 ± 2.0 years) in the inguinal group and from 1 year to 10 years (mean 4.6 ± 2.8 years) in the scrotal group. Operative time was significantly lower in the scrotal group (p < 0.0001). The early minor complication rate did not differ between the two groups. Furthermore, there were no major complications noted. None of the patients had hydrocele recurrence after a mean follow-up of 6 months. The advantages of the scrotal approach for the treatment of communicating hydrocele are as follows: it is well tolerated, simple, and cosmetically appealing, and it has a short operative time in comparison with the standard inguinal approach. The scrotal incision technique is an effective alternative in communicating hydrocele treatment.
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Affiliation(s)
| | | | - Yusuf Kibar
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Unal Zorba
- School of Medicine, Rize University, Rize, Turkey
| | | | - Engin Kaya
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Murat Dayanc
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
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Saka R, Okuyama H, Sasaki T, Nose S, Yoneyama C. Safety and efficacy of laparoscopic percutaneous extraperitoneal closure for inguinal hernias and hydroceles in children: a comparison with traditional open repair. J Laparoendosc Adv Surg Tech A 2013; 24:55-8. [PMID: 24180356 DOI: 10.1089/lap.2013.0109] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Laparoscopic procedures for inguinal hernias and hydroceles in children have become widespread in the past few decades. The purpose of this study was to perform a retrospective analysis of our experience in order to assess the safety and efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) and to compare the findings with those of conventional open repair (OR). SUBJECTS AND METHODS We analyzed the medical records of 488 patients who underwent LPEC or OR for inguinal hernia or hydrocele at our institute between April 2008 and December 2012. The indications for the operation, length of the operation, complications, day surgery, contralateral patent processus vaginalis, and incidence of metachronous contralateral hernia were investigated. The chi-squared test, unpaired t test, and Steel-Dwass test were used to analyze the significance of the data. RESULTS Among a total of 488 patients, 326 patients underwent LPEC (125 males and 201 females), and 162 underwent OR (140 males and 22 females). There was no significant difference in the incidence of recurrence (three in the LPEC and none in the OR group, P=.55) or in the success rates of day surgery (97.8% in LPEC versus 97.6% in OR). The incidence of metachronous contralateral hernias in the LPEC group was lower than that in the OR group (LPEC 0%; OR 2.2%, P=.03). Seventeen subjects with hydroceles were treated by LPEC without any complications. CONCLUSIONS LPEC is safe and effective for inguinal hernias and hydroceles in children, regardless of age, sex, and incarceration and could reduce the incidence of metachronous contralateral hernias.
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Affiliation(s)
- Ryuta Saka
- Department of Pediatric Surgery, Hyogo College of Medicine , Hyogo, Japan
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Pini G, Rassweiler J. Minilaparoscopy and laparoendoscopic single-site surgery: mini- and single-scar in urology. MINIM INVASIV THER 2012; 21:8-25. [PMID: 22211914 DOI: 10.3109/13645706.2011.650179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To review the development of laparoscopic single-site surgery (LESS) and minilaparoscopy (ML), with particular attention to the urological field, focusing on nomenclature, history and outcomes. METHODS A literature search was conducted on laparoendoscopic single-site surgery, minilaparoscopy, needlescopy and microlaparoscopy. The most relevant papers were selected over the last 30 years. RESULTS 830 manuscripts were found about LESS, 251 in urology, two CRTs and nine match-case controls. 258 papers were about ML and 55 in urology. ML is the main topic (169 papers), followed by needlescopy (58) and microlaparoscopy (32). The most significant articles are four non-randomized match-case control studies. CONCLUSIONS Over the last few years, many urological laparoscopic operations have been successfully performed by LESS. However, the actual role of LESS remains to be determined with controversial data about postoperative pain control and almost no results on cosmesis. We are facing second-generation ML with superior performance granted by new endoscopes and most effective instruments. ML has demonstrated in almost all urologic indications to be feasible, safe and able to improve cosmetic and postoperative pain control. Anyway, CRTs are still lacking and only studies from other discipline can corroborate this trend.
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Affiliation(s)
- Giovannalberto Pini
- Department of Urology, SLK Clinics Heilbronn, University of Heidelberg, Germany
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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