Retroperitoneoscopic laparo-endoscopic single-site radical nephrectomy (RLESS-RN): initial experience with a homemade port

Retroperitoneal Laparoendoscopic Single-Incision Radical Nephrectomy Without Special Platforms: A Single-Center Initial Experience

OBJECTIVES

To describe the initial experience of retroperitoneal laparoendoscopic single-incision radical nephrectomy (LESI-RN) without special platforms and use of conventional laparoscopic instruments and assess the safety and feasibility of LESI-RN.

SUBJECTS AND METHODS

Twenty patients who underwent LESI-RN were enrolled in this study. A 5-cm arc skin incision was performed at the midpoint between the costal arch and iliac crest on the midaxillary line. Trocars of 10, 5, and 11 mm were placed at the middle, left end, and right end of the arc incision, respectively. Demographic parameters and perioperative data were retrospectively analyzed and compared with the patients who underwent conventional retroperitoneal laparoscopic radical nephrectomy (LRN).

RESULTS

The LESI-RN patients had a significantly lower visual analogue scale (4.4 ± 1.9 versus 5.6 ± 1.4; P = .031) and analgesic requirement (18.5 ± 11.2 versus 28.6 ± 16.1; P = .026) compared with the conventional LRN group. The operation time in the LESI-RN group was longer than that in the conventional LRN group (P = .001). The two procedures were essentially similar in terms of the time to liquid intake and hospital stay after operation (P > .05).

CONCLUSIONS

LESI-RN is a safe and feasible surgical strategy, which combines the common principles of using straight instruments and working triangulation in conventional LRN with advantages of cosmesis and minimal invasiveness in laparoendoscopic single-site surgery. The surgical and oncological efficacy of LESI-RN is similar to that of conventional LRN but with significantly improved control of postoperative pain and cosmetic results.

Retroperitoneal laparoscopic single-site nephroureterectomy: Initial operative experience

INTRODUCTION

Our aim was to describe our early experience with laparoendoscopic single-site surgery (LESS) via the retroperitoneal approach for upper urinary tract tumors.

METHODS

Since April 2010, 21 patients with upper urinary tract cell carcinoma were treated by our team: 12 patients have undergone LESS nephroureterectomy and 9 have undergone standard retroperitoneal laparoscopic surgery. In our LESS procedure, we employed a bendable grasper in the non-dominant hand and a standard straight laparoscopic instrument in the dominant hand. Nephrectomy was performed using procedures similar to those of conventional laparoscopic nephrectomy. In standard laparoscopic nephroureterectomy, the distal ureter and bladder cuff were excised by using the open method.

RESULTS

All operations using retroperitoneal LESS nephroureterectomy were completed without conversion to standard laparoscopy or open surgery. No intraoperative or acute postoperative complications occurred. We compared the results of the retroperitoneal single-port laparoscopic surgery group to the standard retroperitoneal laparoscopic surgery group and found that the retroperitoneal LESS nephroureterectomy had significantly less estimated blood loss (P = 0.034). No significant difference was noted with respect to age, BMI, operation time, time to oral intake, length of hospitalization, and the visual analog pain scale score at discharge ( P > 0.05).

CONCLUSION

The initial reports of retroperitoneal LESS nephroureterectomy demonstrate that the technique is a safe and feasible procedure for upper urinary tract urothelial carcinoma.