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Ganesan V, Steinberg RL, Garbens A, Trivedi H, Sorokin I, Roehrborn CA, Johnson BA, Gahan JC. Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis. J Robot Surg 2021; 16:295-300. [PMID: 33837950 DOI: 10.1007/s11701-021-01236-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/02/2021] [Indexed: 01/18/2023]
Abstract
Robotic-assisted simple prostatectomy (RASP) has proven to be an effective minimally invasive option for benign prostatic enlargement (BPE) in recent years. Single-site surgery is theorized to reduce post-operative pain beyond traditional minimally invasive approaches. We sought to assess whether use of a single-port robotic platform decreases post-operative opioid use in patients undergoing robotic-assisted simple prostatectomy (RASP). A retrospective review was performed of all patients undergoing RASP our institution from November 2017 to July 2019. Demographic, intraoperative, and post-operative data, including morphine equivalent (ME) use, were collected. Patients were stratified by robotic platform utilized. Propensity score matching using nearest neighbor method was performed using prostate volume, Charlson comorbidity index (CCI), and post-op ketorolac use in 4:1 fashion. Chi-squared analysis and Kruskal-Wallis analyses were utilized. Two-hundred-and-seven men underwent RASP. After matching, 80 patients (64 multi-port, 16 single-port) were included in the analysis. Groups were comparable for age, body mass index, CCI, prostate volume, prior opioid use, and use of scheduled ketorolac post op. The single-port approach was associated with a reduction in MEs once admitted to the floor (5 vs. 11 mg, p = 0.025) and an increase in the proportion of patients who did not require any narcotics post-operatively (44 vs. 19%, p = 0.036). In a propensity matched cohort of patients undergoing RASP at a single institution, use of the single-port robotic system conferred a significant decrease in post-operative narcotic use by approximately 50%.
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Affiliation(s)
- Vishnu Ganesan
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Ryan L Steinberg
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Alaina Garbens
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Hersh Trivedi
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Igor Sorokin
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Claus A Roehrborn
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Brett A Johnson
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA.
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Musquera M, Calvo CI, Vetorazzo J, Ajami T, Ribal MJ, Peri L, Alcaraz A. Laparoendoscopic single-site simultaneous bilateral nephrectomy: first reported case series. Cent European J Urol 2021; 74:44-47. [PMID: 33976914 PMCID: PMC8097648 DOI: 10.5173/ceju.2021.0276.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022] Open
Abstract
Bilateral renal tumors in patients on dialysis are usually managed with bilateral nephrectomy. With traditional laparoscopy, this procedure requires the insertion of multiple trocars. Laparoendoscopic single-site surgery (LESS) uses a single umbilical incision to insert multiple instruments and is also employed for extraction of specimens. This technique appears especially useful for bilateral nephrectomy, since many access ports can be spared. We describe 5 cases of simultaneous bilateral radical nephrectomies performed at a single academic institution. We had no intraoperative complications and a mean operating time of 155 minutes. Four patients could be resected using this approach; one case was converted to a traditional laparoscopy. One case had a postoperative complication. We believe this technique is feasible, and can be accomplished with acceptable morbidity and ade-quate operative time.
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Affiliation(s)
- Mireia Musquera
- Clinic Institute of Nephrology and Urology (ICNU), Universidad de Barcelona, Barcelona, Spain
| | - Carlos Ignacio Calvo
- Departamento Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Vetorazzo
- Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Tarek Ajami
- Clinic Institute of Nephrology and Urology (ICNU), Universidad de Barcelona, Barcelona, Spain
| | - María José Ribal
- Clinic Institute of Nephrology and Urology (ICNU), Universidad de Barcelona, Barcelona, Spain
| | - Lluis Peri
- Clinic Institute of Nephrology and Urology (ICNU), Universidad de Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Clinic Institute of Nephrology and Urology (ICNU), Universidad de Barcelona, Barcelona, Spain
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Reduced port laparoscopic radical nephrectomy using an umbilical zigzag skin incision for renal cell carcinoma. Int Cancer Conf J 2020; 9:212-216. [PMID: 32904008 DOI: 10.1007/s13691-020-00426-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/15/2020] [Indexed: 12/31/2022] Open
Abstract
Reduced port laparoscopic radical nephrectomy (RPLRN) is an equivalent approach to conventional laparoscopic radical nephrectomy (LRN). In LRN, one wound generally needs to be extended for specimen extraction; therefore, some ingenuity is needed to achieve a good cosmetic outcome. We herein describe our initial experience of RPLRN using an umbilical zigzag skin incision for renal cell carcinoma (RCC). A 64-year-old female [body mass index (BMI): 20.0 kg/m2] was diagnosed with right RCC, which was 35 mm in diameter (clinical T1aN0M0). Case 2: a 68-year-old male (BMI: 23.2 kg/m2) was diagnosed with right RCC, which was 58 mm in diameter (clinical T1bN0M1), and perinephric fat was relatively thick. The procedure was safely completed in both cases. Total operative times, pneumoperitoneal times, and estimated blood loss in Case 1 and 2 were 90 and 145 min, 49 and 90 min, and 5 and 80 ml, respectively, and the times required to construct umbilical ports and close umbilical wounds were 8 and 9 min and 33 and 46 min, respectively. In Case 1, the specimen was easily extracted without the extension of the umbilical skin incision, whereas it was extended by an additional 2 cm in Case 2. The umbilical wound was inconspicuous in both cases. RPLRN using an umbilical zigzag skin incision for RCC was safely performed without complications, and clashing between instruments was minimized. The high level of cosmesis is advantageous and an umbilical zigzag skin incision may contribute to more widespread use of RPLRN for RCC; however, further studies on long-term oncological outcomes are needed.
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Laparoendoscopic single-site nephrectomy versus conventional laparoendoscopic nephrectomy for kidney tumor: a systematic review and meta-analysis. Biosci Rep 2019; 39:BSR20190014. [PMID: 31358687 PMCID: PMC6689106 DOI: 10.1042/bsr20190014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 01/18/2023] Open
Abstract
With the increasing application of laparoendoscopic single-site nephrectomy (LESS-N) in kidney tumor, accumulating studies compared it with conventional laparoendoscopic nephrectomy (CL-N). However, controversial outcomes were reported. Hence, this meta-analysis was carried out to clarify these issues. Online databases PubMed, EMBASE and the Cochrane Library were searched comprehensively for eligible studies published before 24 July 2018. Odds ratios (ORs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were collected for evaluating the pooled results of relevant outcomes. Ultimately, 13 eligible articles were enrolled. Meanwhile, compared with CL-N, LESS-N was related to a longer operation time (SMD: 0.40; 95% CI, 0.23–0.58; P=0.000), a shorter length of hospital stay (LOS) (SMD: −0.32; 95% CI, −0.62 to −0.02; P=0.034), a lower visual analog scale (VAS) score (SMD: −0.89; 95% CI, −1.22 to −0.56; P=0.000) and a lower analgesic requirement (SMD: −0.55; 95% CI, −0.87 to −0.23; P=0.001). There was no statistical difference in the postoperative day of oral intake, estimated blood loss (EBL), conversion rate, perioperative complications, intraoperative complications, postoperative complications, minor complications and major complications between LESS-N and CL-N. Patients with LESS-N for kidney tumor could have a longer operation time and shorter LOS, and meanwhile could need less analgesics and suffer less pain after LESS-N.
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Abdel-Karim AM, El Tayeb MM, Yahia E, Elmissiry M, Hassouna M, Elsalmy S. Evaluation of the Role of Laparoendoscopic Single-Site Surgery vs Minilaparoscopy for Treatment of Upper Urinary Tract Pathologies: Prospective Randomized Comparative Study. J Endourol 2018; 31:1237-1242. [PMID: 29020831 DOI: 10.1089/end.2017.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. PATIENTS AND METHODS Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively (p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively (p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively (p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively (p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively (p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. CONCLUSION Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome.
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Affiliation(s)
- Aly M Abdel-Karim
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Marawan M El Tayeb
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Elsaid Yahia
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mostafa Elmissiry
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mohamed Hassouna
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Salah Elsalmy
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
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First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform. J Robot Surg 2017; 12:381-385. [DOI: 10.1007/s11701-017-0724-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
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Gupta A, Ahmed K, Kynaston HG, Dasgupta P, Chlosta PL, Aboumarzouk OM. Laparoendoscopic single-site donor nephrectomy (LESS-DN) versus standard laparoscopic donor nephrectomy. Cochrane Database Syst Rev 2016; 2016:CD010850. [PMID: 27230690 PMCID: PMC6823261 DOI: 10.1002/14651858.cd010850.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Advances in minimally invasive surgery for live kidney donors have led to the development of laparoendoscopic single site donor nephrectomy (LESS-DN). At present, laparoscopic donor nephrectomy is the technique of choice for donor nephrectomy globally. Compared with open surgical approaches, laparoscopic donor nephrectomy is associated with decreased morbidity, faster recovery times and return to normal activity, and shorter hospital stays. LESS-DN differs from standard laparoscopic donor nephrectomy; LESS-DN requires a single incision through which the procedure is performed and donor kidney is removed. Previous studies have hypothesised that LESS-DN may provide additional benefits for kidney donors and stimulate increased donor rates. OBJECTIVES This review looked at the benefits and harms of LESS-DN compared with standard laparoscopic nephrectomy for live kidney donors. SEARCH METHODS We searched the Cochrane Kidney and Transplant's Specialised Register to 28 January 2016 through contact with the Information Specialist using search terms relevant to this review. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared LESS-DN with laparoscopic donor nephrectomy in adults. DATA COLLECTION AND ANALYSIS Three authors independently assessed studies for eligibility and conducted risk of bias evaluation. Summary estimates of effect were obtained using a random-effects model and results were expressed as risk ratios (RR) or risk difference (RD) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. MAIN RESULTS We included three studies (179 participants) comparing LESS-DN with laparoscopic donor nephrectomy. There were no significant differences between LESS-DN and laparoscopic donor nephrectomy for mean operative time (2 studies, 79 participants: MD 6.36 min, 95% CI -11.85 to 24.57), intra-operative blood loss (2 studies, 79 participants: MD -8.31 mL, 95% CI -23.70 to 7.09), or complication rates (3 studies, 179 participants: RD 0.05, 95% CI -0.04 to 0.14). Pain scores at discharge were significantly less in the LESS-DN group (2 studies, 79 participants: MD -1.19, 95% CI -2.17 to -0.21). For all other outcomes (length of hospital stay; length of time to return to normal activities; blood transfusions; conversion to another form of surgery; warm ischaemia time; total analgesic requirement; graft loss) there were no significant differences observed.Although risk of bias was assessed as low overall, one study was assessed at high risk of attrition bias. AUTHORS' CONCLUSIONS Given the small number and size of included studies it is uncertain whether LESS-DN is better than laparoscopic donor nephrectomy. Well designed and adequately powered RCTs are needed to better define the role of LESS-DN as a minimally invasive option for kidney donor surgery.
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Affiliation(s)
- Ameet Gupta
- University Hospital WalesDepartment of UrologyHeath ParkCardiffUKCF14 4XW
| | - Kamran Ahmed
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Howard G Kynaston
- University Hospital WalesDepartment of UrologyHeath ParkCardiffUKCF14 4XW
| | - Prokar Dasgupta
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Piotr L Chlosta
- Jagiellonian University, Collegium MedicumDepartment of UrologyGrzegorzecka 18KrakowPoland31531
| | - Omar M Aboumarzouk
- Islamic University of GazaDepartment of UrologyCollege of MedicineGazaPalestine
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Hiess M, Seitz C. Robot-assisted renal surgery: current status and future directions. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2016; 3:1-12. [PMID: 30697551 PMCID: PMC6193442 DOI: 10.2147/rsrr.s71328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This paper examines the current role of robot-assisted renal surgery as complex and partial nephrectomies, including vena cava thrombus, combined nephroureterectomies, living donor nephrectomy, autotransplantation, and difficult anatomy as in patients with obesity or adhesions. Indications for robot-assisted renal surgery are comparable to those of conventional laparoscopic approaches. A reduction in the learning curve leads to a stabilization of the procedure and further increases the number of minimally invasive procedures performed. A Medline literature search for publications on the field of robotic kidney surgery has been performed using the MeSH terms: robotic surgical procedures and kidney. Future directions include progress in robotic technology and instrumentation with further miniaturization of robotic procedures as laparoendoscopic single-site interventions and progress in image-guided robotic surgery.
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Affiliation(s)
- Manuela Hiess
- Department of Urology, Medical University of Vienna, Vienna, Austria,
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria,
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Choi YH, Lee HW, Lee SY, Han DH, Seo SI, Jeon SS, Lee HM, Choi HY, Jeong BC. Laparoendoscopic single-site simple nephrectomy using a magnetic anchoring system in a porcine model. Investig Clin Urol 2016; 57:208-14. [PMID: 27195320 PMCID: PMC4869569 DOI: 10.4111/icu.2016.57.3.208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/11/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose Magnetic anchoring devices may reduce the number of port sites needed in laparoscopic surgery. In this study, we prospectively assessed the feasibility of using a magnetic anchoring and guidance system (MAGS) in laparoendoscopic single-site (LESS) surgery performed by novices. Materials and Methods A total of 10 LESS simple nephrectomies were performed with or without MAGS in a nonsurvival porcine model by 6 operators with no previous LESS surgery experience. After installation of the homemade single port, an intra-abdominal magnet was fixed to the renal parenchyma with suturing and stabilized by an external magnet placed on the flank so that the position of the kidney could be easily changed by moving the external handheld magnet. The length of the procedure and any intraoperative complications were evaluated. Results Operative time (mean±standard deviation) was shorter in the group using the magnetic anchoring device (M-LESS-N) than in the group with conventional LESS nephrectomy (C-LESS-N) (63±20.8 minutes vs. 82±40.7 minutes, respectively). Although all nephrectomies were completed uneventfully in the M-LESS-N group, renal vein injury occurred during dissection of the renal hilum in two cases of C-LESS-N and was resolved by simultaneous transection of the renal artery and vein with an Endo-GIA stapler. Conclusions LESS-N using MAGS is a feasible technique for surgeons with no LESS surgery experience. Taking into account the 2 cases of renal vein injury in the C-LESS-N group, the application of MAGS may be beneficial for overcoming the learning curve of LESS surgery.
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Affiliation(s)
- Young Hyo Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Won Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo Yeon Lee
- Department of Urology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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de Araújo FBC, Starling ES, Maricevich M, Tobias-Machado M. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study. J Minim Access Surg 2014; 10:197-201. [PMID: 25336820 PMCID: PMC4204263 DOI: 10.4103/0972-9941.141521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/10/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. BACKGROUND: TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. PATIENTS AND METHODS: Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. RESULTS: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. CONCLUSION: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.
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Affiliation(s)
| | | | - Marco Maricevich
- General Surgery Department, Mayo Clinic, Rochester, Minnesota, United States
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Abstract
Historically, open radical nephrectomy (ORN) represented the standard of care for localized renal cell carcinoma (RCC). While the incidence of T1 RCC is rising, treatment options are developing fast and the standard of care according to European and American guidelines has changed to partial nephrectomy (PN), or laparoscopic radical nephrectomy in patients not suitable for PN. To assess the implementation of guideline recommendations and to profile recent surgical and technical innovations, we reviewed the current literature. We observed that ORN still represents the most commonly used treatment in T1 RCC patients. Utilization of PN increased over time but implementation is still in progress. Whereas PN is frequently used in tertiary care centers, population-based studies suggest discrepancies in the diffusion of standard of care treatments. Alternative minimally invasive approaches for PN are available but their superiority is not yet proven. Further efforts in improving the training of urologic surgeons are required to continue the implementation of guideline recommendations.
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Affiliation(s)
- Jonas Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Park YH, Kim KT, Ko K, Kim HH. Prospective randomized controlled trial of conventional laparoscopic versus laparoendoscopic single-site radical nephrectomy for localized renal cell carcinoma: a preliminary report regarding quality of life. World J Urol 2014; 33:367-72. [DOI: 10.1007/s00345-014-1322-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 05/07/2014] [Indexed: 01/09/2023] Open
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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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Khanna R, Laydner HK, Isac W, Stein RJ. Laparoendoscopic single-site surgery for renal malignancies. Expert Rev Anticancer Ther 2014; 10:1861-3. [DOI: 10.1586/era.10.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Laparoendoscopic Single-site Nephrectomy Compared with Conventional Laparoscopic Nephrectomy: A 5-year, Single-surgeon Experience. Eur Urol 2013; 64:412-8. [DOI: 10.1016/j.eururo.2013.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/09/2013] [Indexed: 11/21/2022]
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Samarasekera D, Kaouk JH. Laparoendoscopic single-site surgery: will the application of robotics be the great equalizer? Eur Urol 2013; 64:419-20. [PMID: 23835242 DOI: 10.1016/j.eururo.2013.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 06/08/2013] [Indexed: 12/30/2022]
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Pérez-Lanzac A, Soto-Villalva J, Ledo-Cepero M, Garcia-Baquero R, Rosety-Rodriguez J, Madurga-Patuel B, Alvarez-Ossorio-Fernández J. Transumbilical single port surgery with conventional laparoscopic instruments in horseshoe kidney. Actas Urol Esp 2013; 37:311-5. [PMID: 23453298 DOI: 10.1016/j.acuro.2012.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. MATERIAL AND METHODS We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. RESULTS The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 °C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. CONCLUSION Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney is a reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient.
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Kim J, Yu HS, Cho KS, Han WK, Ham WS. A comparative study of laparoendoscopic single-site surgery versus conventional laparoscopy for upper urinary tract malignancies. Korean J Urol 2013; 54:244-8. [PMID: 23614061 PMCID: PMC3630343 DOI: 10.4111/kju.2013.54.4.244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 09/10/2012] [Indexed: 01/02/2023] Open
Abstract
Purpose The proper indication for laparoendoscopic single-site surgery (LESS) in urology is still under debate, especially for malignant diseases. We compared the perioperative outcomes between LESS and conventional laparoscopy (CL) for upper urinary tract malignancies. Materials and Methods We reviewed the records of 75 patients who underwent radical nephrectomy, nephroureterectomy with bladder cuff excision, or partial nephrectomy with the LESS or CL approach between December 2008 and December 2010. We compared characteristics and perioperative outcomes between patients who underwent LESS or CL. All operations were performed by three surgeons using the transperitoneal approach. Results For all three surgery types, no differences in patient characteristics, estimated blood losses, transfusion rates, or durations of hospital stay were found between the two groups. No complications were found between the two groups in those who underwent nephroureterectomy with bladder cuff excision; however, significantly more complications were found in the LESS group than in the CL group in those who underwent radical nephrectomy or partial nephrectomy. Most of the complications with LESS radical nephrectomy occurred in the early introduction period of the technique. Conclusions No significant differences in perioperative outcomes were found between the LESS and CL groups in those who underwent radical nephrectomy or nephroureterectomy with bladder cuff excision. Therefore, the use of LESS in these cases is expected to expand as surgeons gain more experience with this technique and as other technical advances in laparoscopic instruments occur. However, partial nephrectomy with LESS should be performed restrictively considering the current level of surgical skill.
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Affiliation(s)
- Jongchan Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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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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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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Liu C, Pan B, Zheng S, Xu A. Laparoendoscopic single-site surgery for symptomatic renal cyst decortication using a homemade glove port device: initial experience. Urol Int 2012; 89:180-4. [PMID: 22868405 DOI: 10.1159/000339967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Laparoendoscopic single-site surgery (LESS) has recently gained popularity in urology. There are few large series reports on LESS for symptomatic renal cysts. We evaluated the clinical utility and safety of LESS in 62 symptomatic renal cyst decortication patients by using a homemade glove port device. MATERIALS AND METHODS We reviewed our series of 62 LESS for symptomatic renal cyst (20 Bosniak type I and 42 Bosniak type II) decortication performed from November 2009 to December 2010. A homemade glove port device was placed through an umbilical incision. The perioperative clinical parameters were reviewed retrospectively. RESULTS Of 62 cases that underwent LESS for renal cyst ablation successfully, there were no major perioperative complications, but 2 minor complications (transient fever and mild ileus) were found. The mean operative time was 61.4 ± 27.4 min and the mean estimated blood loss was 20.1 ± 11.3 ml. The mean pre- and postoperative pain scores were 6.94 ± 1.1 (range 5-10) and 1.3 ± 1.2 (0-5), respectively (p = 0.000). CONCLUSIONS Our results suggest that LESS is a safe and feasible alternative to conventional laparoscopic surgery for the treatment of symptomatic renal cysts.
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Affiliation(s)
- Chunxiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, PR China
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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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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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Liatsikos EN, Georgiopoulos L, Kallidonis P, Stolzenburg JU. Laparoendoscopic single-site surgery and cancer. Indian J Urol 2012; 28:71-5. [PMID: 22557722 PMCID: PMC3339791 DOI: 10.4103/0970-1591.94961] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To perform a survey of the current state of laparoendoscopic single-site surgery (LESS) and its implementation in the treatment of malignant disease of the urinary tract. Although it is a recent development in the field of laparoscopic surgery with still unproven long-term results, LESS may prove to be more commonly performed in the coming years while managing urologic cancer patients. MATERIALS AND METHODS A PubMed search was conducted using the key words laparoendoscopic single-site surgery, LESS, urologic cancer. Relevant articles were reviewed for data on the management of urologic malignancy with LESS. RESULTS The first articles describing LESS for urologic cancers were published in 2007. Since then, published experience with this technique has increased. LESS has been implemented as an alternative to conventional laparoscopic surgery and open surgery for the treatment of major urologic cancers. The proposed advantages of LESS are the aesthetic benefit of a single incision and a quicker and less painful recovery. Disadvantages are the lack of instrument triangulation, instrument clashing and the steeper learning curve. As this is a fairly recent technical innovation, long-term functional and oncological results for LESS have not yet been published. CONCLUSIONS LESS is a novel technical advance over conventional laparoscopic surgery, and it can be successfully used in the treatment of patients with urologic cancers. Published data support the feasibility and safety of LESS interventions for major urologic cancers, and newer data may assist in finding LESS's ultimate position among therapeutic options for patients with urologic malignancies.
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Park YH, Baik KD, Lee YJ, Kim KT, Kim HH. Learning Curve Analysis for Laparoendoscopic Single-Site Radical Nephrectomy. J Endourol 2012; 26:494-8. [DOI: 10.1089/end.2011.0473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Don Baik
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ju Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Taek Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Okegawa T, Itaya N, Hara H, Nutahara K, Higashihara E. Initial operative experience of single-port retroperitoneal laparoscopic nephrectomy. Int J Urol 2012; 19:778-82. [DOI: 10.1111/j.1442-2042.2012.03026.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bagrodia A, Cadeddu JA. Surgery: are we likely to see more of LESS in urological surgery? Nat Rev Urol 2012; 9:185-6. [PMID: 22450603 DOI: 10.1038/nrurol.2012.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Laparoendoscopic Single-Site Upper Urinary Tract Surgery: Assessment of Postoperative Complications and Analysis of Risk Factors. Eur Urol 2012; 61:510-6. [DOI: 10.1016/j.eururo.2011.08.032] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/11/2011] [Indexed: 12/19/2022]
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Abstract
In the last decade, laparoendoscopic single-site surgery (LESS) has been touted to be the part of the 'evolution' of minimally invasive surgery. The hope is that reduced access points will ultimately decrease pain, morbidity, convalescence, and improve cosmesis. However, what is unique about LESS is that while laparoscopic literature sought to demonstrate superiority of the technique over that of open surgery, the publications on LESS generally seem to seek to demonstrate equivalence with laparoscopy, with the major focus being on cosmesis. Unfortunately, even in that regard the objective cosmesis data is lacking. Furthermore, patients rate cosmesis the least important of all factors. LESS has also been associated with increased risk of complication, increased surgical cost, and longer operative times. In the current review, an objective assessment of the literature will be used for comparison between current standard laparoscopic techniques and LESS with the hopes of answering the question: is LESS really more?
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Affiliation(s)
| | - Achim Lusch
- Department of Urology, University of California Irvine, Irvine, CA, USA
| | - Jaime Landman
- Department of Urology, University of California Irvine, Irvine, CA, USA
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Best SL, Bergs R, Scott DJ, Fernandez R, Mashaud LB, Cadeddu JA. Solo surgeon laparo-endoscopic single site nephrectomy facilitated by new generation magnetically anchored and guided systems camera. J Endourol 2011; 26:214-8. [PMID: 22191662 DOI: 10.1089/end.2011.0143] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION We report a redesigned magnetically anchored and guided systems (MAGS) camera with improved optics and a 30° downward viewing angle that facilitates solitary surgeon laparo-endoscopic single site (LESS) nephrectomy. METHODS The prototype consists of an external 2 by 6 cm cylinder containing magnets positioned such that the intra-abdominal camera is anchored on the peritoneal surface with a default 30° downward angle. It was inserted through a 3 cm LESS-port periumbilical incision in three pigs (mean 47 kg). The camera was coupled with the handheld magnetic device across the anterior abdominal wall and was steered into position to view the kidney. LESS nephrectomy was then performed. RESULTS Since a standard LESS laparoscope was not needed, only the two operative instruments were inserted through the single incision port, significantly decreasing instrument "clashing" compared with traditional LESS nephrectomy. Due to the favorable angle of view of the camera and its self-anchoring capability, no assistant was needed to drive the camera. Instead, the surgeon periodically made minor adjustments to optimize the view. The nephrectomy was completed without complication in an average of 35 minutes in these three nonsurvival animals. CONCLUSION The MAGS camera provides good optics and easy maneuverability during LESS porcine nephrectomy. As with other MAGS instruments, by replacing a traditional transabdominal laparoscope that occupies access port space, use of this insertable camera may diminish some of the "collision challenge" of LESS surgery. Also, by being self-anchoring, this prototype may minimize the need for an assistant surgeon.
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Affiliation(s)
- Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Olweny EO, Mir SA, Best SL, Park SK, Donnally III C, Cadeddu JA, Tracy CR. Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single-site (LESS), laparoscopic and open surgery. BJU Int 2011; 110:268-72. [DOI: 10.1111/j.1464-410x.2011.10784.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors. Surg Endosc 2011; 26:1135-9. [PMID: 22083326 DOI: 10.1007/s00464-011-2012-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/11/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND The safety and feasibility of laparoendoscopic single-site (LESS) adrenalectomy for benign adrenal lesions was proved in early clinical series. However, the advantages of LESS over multiport laparoscopic adrenalectomy still are under investigation. METHODS Since October 2009, the authors have prospectively performed LESS retroperitoneal adrenalectomy for 21 consecutive patients with benign adrenal tumors (LESS group). Another 28 patients with benign adrenal tumors were prospectively collected between June 2006 and October 2009 and served as a multiport laparoscopic adrenalectomy group. The patients' demographic data, operating time, estimated blood loss, peri- and postoperative complications, and short-term outcome were collected for further analysis. RESULTS The demographic data were comparable between the two groups in terms of the patient age, gender, body mass index (BMI), laterality, diagnosis, and resected specimen weight. No major complication or mortality occurred in either group. Neither group had any conversions. No differences were observed between the two groups in terms of intraoperative hemodynamic status or peri- or postoperative complications. The LESS patients had quicker resumption of oral intake (0.18 vs 1 day; p < 0.001), a shorter hospital stay (2 vs 4 days; p < 0.001), and a reduced analgesic requirement postoperatively (0 vs 0.84 mg/kg; p = 0.023) than the multiport laparoscopic patients. CONCLUSIONS The results demonstrate that LESS adrenalectomy is as safe and effective as conventional multiport laparoscopic adrenalectomy for benign adrenal tumors. In addition, LESS adrenalectomy provides short-term convalescence advantages over multiport laparoscopic adrenalectomy.
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Stolzenburg JU, Kallidonis P, Ragavan N, Dietel A, Do M, Thi PH, Till H, Liatsikos EN. Clinical outcomes of laparo-endoscopic single-site surgery radical nephrectomy. World J Urol 2011; 30:589-96. [PMID: 21960202 DOI: 10.1007/s00345-011-0765-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 09/10/2011] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The conventional laparoscopic surgery is now paving way to the new technologies including robotic and laparoscopic single-site surgery (LESS). We present our updated experience on LESS radical nephrectomy (LESS-RN). PATIENTS AND METHODS The data from patients undergoing LESS-RN in our two institutions were reviewed along with various clinical and pathological parameters. RESULTS Between 2008 and 2011, 42 LESS-RN were performed (right = 22, left = 20) with mean (range) age and BMI of 63.7 (33-86) years and 25.1 (18-38.6) kg/m(2), respectively. In addition to the instruments in the single port, one extra 3-mm needlescopic instrument was required in 19 patients (right = 17, left = 2). In three patients, two additional 5-mm trocars and instruments were required. None required open conversion. The recorded adverse events include one bowel injury (intraoperative closure without the need for stoma), one postoperative bleeding requiring blood transfusion, one prolonged ileus, and one deep venous thrombosis. The resected specimens revealed pT1a (n = 3), pT1b (n = 33), pT2a (n = 4), and pT3b (n = 2) tumors. The finding of pT3b was incidental rather than planned procedure. None of the patients had positive margins. CONCLUSION LESS-RN has proven to be feasible and safe. Beyond cosmesis, further advantages of this approach need to be addressed by randomized trials.
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Comparison of Laparoendoscopic Single-Site, Conventional Laparoscopic, and Open Nephrectomy in a Pediatric Population. Urology 2011; 78:74-7. [DOI: 10.1016/j.urology.2010.11.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/19/2010] [Accepted: 11/19/2010] [Indexed: 11/19/2022]
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White MA, Autorino R, Spana G, Laydner H, Hillyer SP, Khanna R, Yang B, Altunrende F, Isac W, Stein RJ, Haber GP, Kaouk JH. Robotic Laparoendoscopic Single-Site Radical Nephrectomy: Surgical Technique and Comparative Outcomes. Eur Urol 2011; 59:815-22. [DOI: 10.1016/j.eururo.2011.02.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/03/2011] [Indexed: 12/01/2022]
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Salas N, Gorin MA, Gorbatiy V, Castle SM, Bird VG, Leveillee RJ. Laparoendoscopic Single Site Nephrectomy With the SPIDER Surgical System: Engineering Advancements Tested in a Porcine Model. J Endourol 2011; 25:739-42. [DOI: 10.1089/end.2010.0608] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nelson Salas
- Joint Bioengineering and Endourology Developmental Surgical (JBEDS) Laboratory, Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
| | - Michael A. Gorin
- Joint Bioengineering and Endourology Developmental Surgical (JBEDS) Laboratory, Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Vladislav Gorbatiy
- Joint Bioengineering and Endourology Developmental Surgical (JBEDS) Laboratory, Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Scott M. Castle
- Joint Bioengineering and Endourology Developmental Surgical (JBEDS) Laboratory, Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Vincent G. Bird
- Joint Bioengineering and Endourology Developmental Surgical (JBEDS) Laboratory, Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Raymond J. Leveillee
- Joint Bioengineering and Endourology Developmental Surgical (JBEDS) Laboratory, Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
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Initial experience with laparoscopic single-incision triangulated umbilical surgery (SITUS) in simple and radical nephrectomy. World J Urol 2011; 30:613-8. [PMID: 21461722 DOI: 10.1007/s00345-011-0670-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 03/01/2011] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION New transumbilical laparoendoscopic procedures are an emerging field in urologic surgery. We introduced the concept of single-incision triangulated umbilical surgery (SITUS) in 2009. SITUS technique uses straight optics and instruments in a triangulated fashion via three trocars placed through an umbilical incision resulting in a familiar laparoscopic environment. Aim of the study was to demonstrate the feasibility of SITUS in simple and radical nephrectomy in daily routine. MATERIALS AND METHODS From October 2009 to July 2010, in 3 patients with cirrhotic kidneys a simple and in 12 patients a radical nephrectomy was performed in SITUS technique. The umbilical fold was incised at three-fourth of its circumference; in the patient with radical nephrectomy, additionally small "c"-shaped skin flaps were removed. After achieving a pneumoperitoneum by Verres technique, a 5-mm camera port and then a cranial 5 mm and a caudal 11 mm working trocar were placed with at a distance of 5-10 cm with the aid of two Langenbeck hooks, thus allowing triangulation except in the radical nephrectomy patients, where an 11-mm caudal trocar (Endopath, Ethicon, Hamburg, GER) was used. Using long conventional laparoscopic instruments, En-Seal pressure coagulator and dissector (Erbe, Tuebingen, Germany), Hem-O-Lock clips (Weck, Teleflex, USA), and a 30° 5-mm optic (Karl Storz, Tuttlingen, GER), the interventions were executed like conventional laparoscopic transperitoneal procedures. RESULTS OR time was mean 127 min [120, 153] for cirrhotic kidney nephrectomy group and mean 137 min [91, 185] in the radical nephrectomy group. Mean hemoglobin drop was 1.5 g/dl [1.2, 1.7] in benign cases and 2.4 [1.1, 4.9] in radial nephrectomies. All except one diabetic patient with wound infection had an uneventful follow-up without postoperative complications. The patients were discharged at postoperative day 5 [3, 29]. CONCLUSION SITUS technique for simple and radical nephrectomy is an attractive alternative to conventional laparoscopy and single-port surgery. It combines the common principles of traditional laparoscopy (straight instruments and triangulation) with single-port surgery (cosmesis and minimally invasiveness) resulting in adequate or time and short learning curve.
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Best SL, Donnally C, Mir SA, Tracy CR, Raman JD, Cadeddu JA. Complications during the initial experience with laparoendoscopic single-site pyeloplasty. BJU Int 2011; 108:1326-9. [DOI: 10.1111/j.1464-410x.2011.10078.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Choi JD, Kim HS, Ju SH, Lee SY, Han DH, Jeong BC. Initial experience with LESS and hybrid LESS in patients with benign urologic disease. MINIM INVASIV THER 2011; 21:63-70. [PMID: 21332257 DOI: 10.3109/13645706.2010.543982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report our initial experience with 100 laparoendoscopic single site (LESS) and hybrid LESS procedures for benign urologic disease. Between December 2008 and April 2010, we performed LESS and hybrid LESS urologic procedures in 100 cases for various benign urologic diseases. Conversion to standard laparoscopy was necessary in six cases, conversion to hand-assisted laparoscopic surgery occurred in one case, and conversion to open surgery was necessary in one case. Intra- and postoperative complications occurred in nine and four cases, respectively. Totally, the mean operative time was 170 minutes, the mean blood loss was 221 ml, and the mean hospital stay was 5.1 days. The mean patient controlled anesthesia (PCA) equivalents used were 81.5 ml and the mean Visual Analog Pain Scale (VAPS) scores at postoperative day 1 and discharge were 3.8 and 2.1, respectively. The study was limited by retrospective design and short-term follow-up periods. LESS and hybrid LESS procedures are technically feasible in a variety of ablative and reconstructive applications of benign urologic diseases. However, apparent benefits of LESS surgical techniques over conventional laparoscopy are needed to be further explored.
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Affiliation(s)
- Jae Duck Choi
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ishida M, Miyajima A, Takeda T, Hasegawa M, Kikuchi E, Oya M. Technical difficulties of transumbilical laparoendoscopic single-site adrenalectomy: comparison with conventional laparoscopic adrenalectomy. World J Urol 2010; 31:199-203. [PMID: 21188386 DOI: 10.1007/s00345-010-0636-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/10/2010] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Interest in laparoendoscopic single-site (LESS) surgery has increased in recent years. The aim of this study was to evaluate the feasibility and safety of transumbilical LESS adrenalectomy and to elucidate the technical differences between LESS and conventional laparoscopic surgery. METHODS This study was comparing 10 consecutive transumbilical LESS adrenalectomies and 10 conventional laparoscopic adrenalectomies performed between March 2006 and April 2010 for benign adrenal tumors. Perioperative parameters were compared, and we reviewed our surgical videos and analyzed technical characteristics of the surgeries. RESULTS There was no open conversion in laparoscopic group, no additional port placement in LESS group, and no perioperative complications in either group. No significant differences in operative time, estimated blood loss, or resumption of oral intake were observed between two groups. Pneumoperitoneum time did not differ between LESS and laparoscopic groups (91.2 vs. 74.3 min, P = 0.257). In LESS group only, time was needed for adjustment of roticulator (14.5 ± 8.1 min). After subtracting the time needed for adjustment, operative time between two groups was more comparable (76.7 vs. 74.3 min, P = 0.880). One-handed manipulation time in LESS group decreased in a time-dependent manner (r = -0.806, P < 0.0049). Tissue re-grasping during operation was more frequently observed in LESS group (16.2 vs. 2.2 times, P < 0.001). CONCLUSIONS Transumbilical LESS adrenalectomy is feasible and comparable to conventional laparoscopic adrenalectomy. There are still obvious technical difficulties associated with LESS surgery, and it is essential that these be overcome in order to improve this surgical technique.
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Affiliation(s)
- Masaru Ishida
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Casanova N, Wolf JS. The alternative to laparoendoscopic single-site surgery: small strategic laparoscopic incision placement (SLIP) nephrectomy improves cosmesis without technical restrictions. J Endourol 2010; 25:265-70. [PMID: 21126191 DOI: 10.1089/end.2010.0340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The latest attempt to improve the cosmesis of laparoscopic surgery is laparoendoscopic single-site surgery (LESS). We present our initial experience with an alternative procedure with similar cosmetic benefit but without technical limitations. METHODS Small strategic laparoscopic incision placement (SLIP) nephrectomy is performed transperitoneally, generally using three 5-mm ports (one in the umbilicus) and one 12-mm port placed below the pubic hairline, such that only two 5-mm scars are visible without close inspection. We assessed our first 21 procedures, which included all but five of the standard transperitoneal nephrectomies by a single surgeon from June 2008 through July 2009. These were matched 1:2 (exactly by gender and American Society of Anesthesiology score, and then closest in age and body mass index) from 96 patients undergoing similar standard transperitoneal laparoscopic procedures from 2005 through 2008. RESULTS The SLIP and control groups were well matched, with mean age and body mass index differing by only 3.6 years and 1.1, respectively. Of the SLIP patients, 34% were obese or morbidly obese, and a trainee was the primary surgeon in 81% of cases. Mean operative time was 23 minutes longer in the SLIP cases. There was no difference between groups in estimated blood loss, complication rate, or convalescence. CONCLUSIONS Like LESS, SLIP nephrectomy provides improved cosmesis. Unlike LESS, it is only slightly more difficult to perform than standard laparoscopic nephrectomy and can be performed in technically challenging cases (obesity, large specimen, etc). Similar to the literature on LESS, there is no convalescence benefit to SLIP nephrectomy; the advantage over standard laparoscopy is purely cosmetic.
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Affiliation(s)
- Nina Casanova
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan, USA
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Abstract
Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. LaparoEndoscopic Single Site (LESS) surgery 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. Technological developments in instrumentation, access and optics devices are overcoming some of the challenges that are raised when operating through a single site. Further advances in the technique have included the incorporation of robotics (R-LESS), which exploit the ergonomic benefits of ex vivo robotic platforms in an attempt to further improve the implementation of LESS procedures. In the future, urologists may be able to benefit from in vivo micro-robots that will allow the manipulation of tissue from internal repositionable platforms. The use of magnetic anchoring and guidance systems (MAGS) might allow the external manoeuvring of intra-corporeal instruments to reduce clashing and facilitate triangulation. However, the final promise in minimally invasive surgery is natural orifice transluminal endoscopic surgery (NOTES), with its scarless technique. It remains to be seen whether NOTES, LESS, or any of these future developments will prove their clinical utility over standard laparoscopic methods.
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Affiliation(s)
- Harveer Dev
- LeFrak Center for Robotic Surgery & Institute for Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
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White MA, Haber GP, Autorino R, Khanna R, Forest S, Yang B, Altunrende F, Stein RJ, Kaouk JH. Robotic Laparoendoscopic Single-Site Radical Prostatectomy: Technique and Early Outcomes. Eur Urol 2010; 58:544-50. [PMID: 20702030 DOI: 10.1016/j.eururo.2010.06.040] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
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Dev HS, Sooriakumaran P, Tewari AK. Single-Site Surgery: More oR-LESS? Eur Urol 2010; 58:849-50. [PMID: 20863610 DOI: 10.1016/j.eururo.2010.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
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