Patient-reported postoperative pain, body image, and cosmetic satisfaction after transumbilical laparoendoscopic single-site adrenalectomy

Longitudinal analysis of retroperitoneoscopic adrenalectomy regarding cosmesis outcomes: comparison of lateral transperitoneal and reduced port laparoscopic adrenalectomy

The aim of this study is to compare patient-reported cosmesis and satisfaction outcomes between lateral retroperitoneoscopic adrenalectomy (LRA), laparoendoscopic single site and reduced port adrenalectomy (LESS/RP-A) and lateral transperitoneal laparoscopic adrenalectomy (LTA). A total of 26, 86 and 50 patients who underwent LRA, LESS/RP-A and LTA were included in the study. All LESS/RP-A cases were performed taking the transumbilical approach. We mailed a questionnaire to all patients 1, 3, 6, 9 and 12 months after operation. Questionnaires inquiring about cosmesis (0: very ugly, 10: very beautiful) on the basis of a visual analogue scale were administered. The mean scores of cosmesis at postoperative months 1, 3, 6, 9 and 12 were 7.11, 7.00, 6.57, 5.25 and 5.46 for the LRA group, 8.43, 8.86, 8.95, 8.46 and 9.09 for the LESS/RP-A group and 7.18, 7.74, 7.58, 7.44 and 8.09 for the LTA group. The difference in cosmesis score between the LRA and LESS/RP-A groups gradually increased after surgery, and the cosmesis score for the LRA group was significantly lower at every postoperative point. The difference in cosmesis score between the LRA and LTA groups gradually increased after surgery, and the cosmesis score for the LRA group was significantly lower at postoperative months 9 (p = 0.015) and 12 (p = 0.002). This study is the first comprehensive longitudinal analysis of patient-reported cosmesis outcomes between LRA, LESS/RP-A and LTA. LRA was the surgical procedure that resulted in lower cosmesis scores when compared with those following the LESS/RP-A and LTA procedures.

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

Background

To investigate the outcomes of laparoendoscopic single-site adrenalectomy (LESS-A) compared to multi-port laparoendoscopic adrenalectomy (m-LA).

Methods

Studies comparing LESS-A with m-LA were identified from PubMed, Embase, and Cochrane Library before June 2020. Post-operative pain, resumption outcomes, and perioperative outcomes were analyzed. We conducted meta-analyses using the Mantel-Haenszel method with random-effects model. Subset analyses were conducted according to peritoneal and retroperitoneal approaches. A small study effect was illustrated using funnel plots and Egger's test.

Results

One randomized controlled trial (RCT) and nineteen retrospective cohort studies involving 1554 patients were included for analyzed. Pooled analysis showed that LESS-A had significantly lower postoperative pain scores (MD −0.77, 95%CI −1.45 to −0.10) and less pain medication used (RR 0.74, 95%CI 0.60 to 0.91) compared to m-LA. Besides, LESS-A had significantly shorter hospital stays (MD −0.75, 95%CI −1.18 to −0.33), shorter duration of oral intake resumption (MD −0.33, 95%CI −0.60 to −0.06), and better cosmetic satisfaction (SMD 1.15, 95%CI 0.21 to −2.09). As for perioperative outcomes, LESS-A led to significant longer operative time (MD 13.43, 95%CI 4.08 to 22.77). No significant differences were observed in terms of the remaining perioperative outcomes.

Conclusions

LESS-A is associated with less post-operative pain and quicker recovery duration. However, the longer operative time of LESS-A compared with m-LA is a drawback.

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Multi-port laparoscopic adrenalectomy (m-LA) is widely used for treatment of benign adrenal tumor.

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Laparoscopic single-site adrenalectomy (LESS-A) had significant less post-operative pain and less pain medication consumption comparing with m-LA.

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LESS-A had better resumption outcomes, including shorter hospital stay and quicker post-operative oral intake.

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LESS-A offer better cosmetic satisfaction.

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Longer operative time is a drawback of LESS-A.

Laparoendoscopic single-site inguinal lymphadenectomy in gynecology: preliminary experience at a single institution

PURPOSE

Laparoendoscopic single-site surgery (LESS), a promising innovation in minimally invasive surgery, has been used in treating gynecologic oncology diseases. There have been no reports in the literature regarding LESS for inguinal lymphadenectomy (LESS-IL) in gynecologic conditions. We aimed to evaluate the feasibility, safety, and outcomes of LESS-IL.

METHODS

Six patients with vulvar or vaginal cancer underwent LESS-IL from July 2018 to March 2019. Data regarding the intraoperative and postoperative outcomes were analyzed.

RESULTS

All patients successfully underwent a bilateral LESS-IL without conversion. LESS pelvic lymphadenectomy via an umbilical incision was also performed in a patient with vaginal cancer. The median operation time for the single-port laparoendoscopic inguinal lymphadenectomies was 105 min (range 70-134), with a median estimated blood loss of 108 ml (range 40-170). Median time of hospitalization was 7.5 days (range 5-10). A median of 11 (6-15) lymph nodes were dissected in a unilateral groin. The suction drains were removed after a median duration of 5 days (range 3-7). There were no skin-related or lymph-related postoperative complications. At a median follow-up period of 9 months, all the patients were alive and no recurrence was found.

CONCLUSION

LESS-IL is a feasible and safe technique for the surgical management of gynecologic cancers.

Longitudinal analysis of laparoendoscopic single-site adrenalectomy and conventional laparoscopic adrenalectomy regarding patient-reported satisfaction and cosmesis outcomes

BACKGROUND/OBJECTIVE

To compare longitudinal patient-reported cosmesis of laparoendoscopic single-site adrenalectomy (LESS-A) to that of conventional laparoscopic adrenalectomy (CLA).

METHODS

A total of 23, 15, and 9 patients underwent transumbilical LESS-A (TU-LESS), subcostal LESS-A (SC-LESS), and CLA, respectively. A questionnaire was administered asking the patient to assess wound pain (0: not painful to 10: very painful), satisfaction (0: not satisfied to 10: very satisfied), and cosmesis (0: very ugly to 10: very beautiful) on the basis of a visual analogue scale. We mailed questionnaires to all patients who received LESS-A and CLA at postoperative 1, 3, 6, 9, and 12 months.

RESULTS

No significant differences were observed in the pain scores between TU-LESS, SC-LESS, and CLA at every time point. In the CLA group, the cosmesis and satisfaction scores were significantly lower at postoperative 3 months (p = 0.0033, 0.0130). There were no significant inter-group differences in the cosmesis score between the three groups after postoperative 6 months. However, the satisfaction score of SC-LESS decreased after postoperative 3 months and was significantly lower at postoperative 9 and 12 months (p = 0.0333, 0.0160). The difference between the satisfaction scores of each procedure gradually increased after postoperative 6 months.

CONCLUSION

This study is the first comprehensive longitudinal analysis of patient-reported satisfaction and cosmesis outcomes between LESS-A and CLA. The resulting data provide important insights into the improvement in satisfaction in patients who underwent TU-LESS. These findings can facilitate the treatment decision-making process for patients who are considering laparoscopic adrenalectomy.

Rapid titration of opiate doses via patient-controlled intravenous analgesia for patients with severe cancer pain

This study was to investigate the feasibility and safety of patient-controlled intravenous analgesia for opiate titration in patients with severe cancer. Eligible patients with cancer pain were randomly divided into two groups, which were titrated with a subcutaneous injection of morphine and patient-controlled intravenous analgesia, respectively. The time required for patients to begin titration to reach visual analog scale score ⩽ 3, the adverse reactions during titration, the time spent by nurses in titrating each patient, and the time to complete the titration with a delayed-release dosage form analgesic effect and adverse reaction. The mean titration time of patient-controlled intravenous analgesia group (1.09 ± 0.82 vs 2.97 ± 1.98) and morphine dosage (18.78 ± 12.32 vs 13.23 ± 8.07) were significantly lower than those in the subcutaneous group ( P < 0.05). The incidences of nausea, vomiting, pruritus, urinary retention, and sedation in the subcutaneous injection group were significantly lower than those in the subcutaneous injection group ( P < 0.05). The assessment times of the two groups (10.19 ± 3.72 vs 10.25 ± 4.88) were similar ( P > 0.05). However, the time required for subcutaneous injection in patients under patient-controlled intravenous analgesia was significantly lower than that in the subcutaneous injection group (36.36 ± 12.15 vs 132.36 ± 32.79), which was statistically significant ( P < 0.05). After the titration, the controlled release opioid was used to treat cancer pain. The visual analog scale score of the patient-controlled intravenous analgesia group was significantly lower than that of the subcutaneous group (2.44 ± 1.37 vs 2.73 ± 0.91) at 7 days after treatment in the subcutaneous group (1.05 ± 0.30 vs 2.45 ± 1.29; P < 0.05). Patient-controlled intravenous analgesia technique can effectively and quickly complete the titration of cancer pain treatment with less occupational care resources and is better than the subcutaneous injection titration.

Long-Term Outcomes of Laparoendoscopic Single-Site Nephrolithotomy for Caliceal Diverticular Calculi: A Case Series

OBJECTIVE

To evaluate the outcomes of laparoendoscopic single-site nephrolithotomy (LESS-NL) for symptomatic caliceal diverticular calculi.

PATIENTS AND METHODS

From November 2009 to March 2014, 11 cases of LESS-NL with a homemade single-port device for caliceal diverticular calculi were performed by a single experienced laparoscopic surgeon. All patients were assessed at postoperative 1 month, 1 year, and 3 years for symptom-free status and by CT for stone-free and caliceal diverticular obliteration status. All complications were categorized by the Clavien-Dindo classification. Demographic parameters and postoperative outcomes were retrospectively analyzed.

RESULTS

All procedures were effectively performed without conversion to open or conventional laparoscopic surgery. Median patient age was 53 years (range 22-73), and median diverticular size was 26 mm (range 15-58). Six patients (54.5%) had multiple stones, and five patients (45.5%) had a single stone; median stone size was 20.6 mm (range 12.1-66.4). The transperitoneal approach was used in seven patients (63.6%) and retroperitoneal approach in four patients (36.4%). Median operative time was 161 minutes (range 110-250), median estimated blood loss was 50 mL (range 20-400), and median hospital stay was 4 days (range 3-6). An additional needlescopic instrument was used in five cases (45.5%). There were three cases (27.3%) of grade I complications (two postoperative fever, one ileus), and no intraoperative or major complications. Median visual analog scale score significantly improved by discharge day (from 4.9 preoperatively to 1.4; p = 0.003). After a median follow-up of 38 months (range 36-41), all patients were symptom free with no evidence of stone or caliceal diverticulum on imaging.

CONCLUSIONS

LESS-NL is a safe, feasible, and definitive treatment option for symptomatic caliceal diverticular calculi.