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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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Diaz-Nieto R, Vyas S, Sharma D, Malik H, Fenwick S, Poston G. Robotic Surgery for Malignant Liver Disease: a Systematic Review of Oncological and Surgical Outcomes. Indian J Surg Oncol 2019; 11:565-572. [PMID: 33281400 DOI: 10.1007/s13193-019-00945-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/21/2019] [Indexed: 12/23/2022] Open
Abstract
Robot-assisted laparoscopic surgery is yet another modification of minimally invasive liver surgery. It is described as feasible and safe from the surgical point of view; however, oncological outcomes need to be adequately analysed to justify the use of this technique when resecting malignant liver tumours. We reviewed existing English medical literature on robot-assisted laparoscopic liver surgery. We analysed surgical outcomes and oncological outcomes. We analysed operative parameters including operative time, type of hepatectomy, blood loss, conversion rate, morbidity and mortality rates and length of stay. We also analysed oncological outcomes including completeness of resection (R status), recurrence, survival and follow-up data. A total of 582 patients undergoing robot-assisted laparoscopic liver surgery were analysed from 17 eligible publications. Only 5 publications reported survival data. The overall morbidity was 19% with 0.2% reported mortality. R0 resection was achieved in 96% of patients. Robotic liver surgery is feasible and safe with acceptable morbidity and oncological outcomes including resection margins. However, well-designed trials are required to provide evidence in terms of survival and disease-free intervals when performed for malignancy.
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Affiliation(s)
- Rafael Diaz-Nieto
- Hepatobiliary Surgery Unit, Aintree University Hospital, Longmoor Ln, L9 7AL, Liverpool, UK
| | - Soumil Vyas
- Division of HPB surgery, Surgical Gastroenterology and Surgical Oncology Sir H N Reliance Foundation Hospital, Mumbai, India
| | - Dinesh Sharma
- HPB/Liver Transplant Surgery Unit, Royal Free Hospital, London, UK
| | - Hassan Malik
- Hepatobiliary Surgery Unit, Aintree University Hospital, Longmoor Ln, L9 7AL, Liverpool, UK
| | - Stephen Fenwick
- Hepatobiliary Surgery Unit, Aintree University Hospital, Longmoor Ln, L9 7AL, Liverpool, UK
| | - Graeme Poston
- Hepatobiliary Surgery Unit, Aintree University Hospital, Longmoor Ln, L9 7AL, Liverpool, UK
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Laparoscopic nephrectomy in dogs: An initial experience of 16 experimental procedures. Vet J 2013; 198:513-7. [DOI: 10.1016/j.tvjl.2013.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 08/12/2013] [Accepted: 08/19/2013] [Indexed: 11/19/2022]
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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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Natalin RA, Lima FS, Pinheiro T, Vicari E, Ortiz V, Andreoni C, Landman J. The final stage of the laparoscopic procedure: exploring final steps. Int Braz J Urol 2012; 38:4-16. [DOI: 10.1590/s1677-55382012000100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2011] [Indexed: 11/21/2022] Open
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Laparo-endoscopic single-site surgery for radical and cytoreductive nephrectomy, renal vein thrombectomy, and partial nephrectomy: a prospective pilot evaluation. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2010; 2010:107482. [PMID: 20631830 PMCID: PMC2901611 DOI: 10.1155/2010/107482] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 02/21/2010] [Accepted: 03/23/2010] [Indexed: 01/23/2023]
Abstract
Introduction. Laparo-endoscopic single-site surgery (LESS) may diminish morbidity of laparoscopic surgery. We prospectively evaluated feasibility and outcomes of LESS-Radical Nephrectomy (LESS-RN) and Partial Nephrectomy (LESS-PN). Methods. 10 patients underwent LESS-RN (6) and LESS-PN (4) between 2/2009-5/2009. LESS-RN included 2 with renal vein thrombectomy, one of which was also cytoreductive. Transperitoneal LESS access was obtained by periumbilical incision. Patient/tumor characteristics, oncologic, and quality of life (QoL) outcomes were analyzed. Results. 3 Men/7 Women (mean age 58.7 years, median follow-up 9.8 months) underwent LESS. 9/10 cases were completed successfully. All had negative margins. Mean operative time was 161 minutes, estimated blood loss was 125 mL, and incision size was 4.4 cm. Median tumor size for LESS-RN and -PN was 5.0 and 1.7 cm (P = .045). Median LESS-PN ischemia time was 24 minutes; mean preoperative/postoperative creatinine were 0.7/0.8 mg/dL (P = .19). Mean pain score at discharge was 1.3. Mean preoperative, 3-, and 6-month postoperative SF-36 QoL Score was 73.8, 74.4 and 77.1 (P = .222). All patients are currently alive. Conclusions. LESS-RN, renal vein thrombectomy, and PN are technically feasible and safe while maintaining adherence to oncologic principles, with excellent QoL preservation and low discharge pain scores. Further study is requisite.
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Wu SD, Lesani OA, Zhao LC, Johnston WK, Wolf JS, Clayman RV, Nadler RB. A Multi-Institutional Study on the Safety and Efficacy of Specimen Morcellation After Laparoscopic Radical Nephrectomy for Clinical Stage T1 or T2 Renal Cell Carcinoma. J Endourol 2009; 23:1513-8. [DOI: 10.1089/end.2009.0387] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simon D. Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - O. Alex Lesani
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lee C. Zhao
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William K. Johnston
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J. Stuart Wolf
- Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Ralph V. Clayman
- Department of Urology, University of California Irvine Medical Center, Orange, California
| | - Robert B. Nadler
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Gabr AH, Gdor Y, Strope SA, Roberts WW, Wolf JS. Approach and Specimen Handling Do Not Influence Oncological Perioperative and Long-Term Outcomes After Laparoscopic Radical Nephrectomy. J Urol 2009; 182:874-80. [DOI: 10.1016/j.juro.2009.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Ahmed H. Gabr
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Yehoshua Gdor
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Seth A. Strope
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - William W. Roberts
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - J. Stuart Wolf
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
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Yoost TR, McIntyre M, Savage SJ. Continuous Infusion of Local Anesthetic Decreases Narcotic Use and Length of Hospitalization After Laparoscopic Renal Surgery. J Endourol 2009; 23:623-6. [DOI: 10.1089/end.2008.0586] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy R. Yoost
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Matthew McIntyre
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Stephen J. Savage
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
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Bird VG, Au JK, Sandman Y, Santos RDL, Ayyathurai R, Shields JM. Comparison of Different Extraction Sites Used During Laparoscopic Radical Nephrectomy. J Urol 2009; 181:1565-70. [DOI: 10.1016/j.juro.2008.11.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Vincent G. Bird
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jason K. Au
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Yekutiel Sandman
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rosely De Los Santos
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rajnikanth Ayyathurai
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - John M. Shields
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
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Affiliation(s)
- Leslie A Deane
- Department of Urology, University of California Irvine, UCI Medical Center, Orange, CA 92868, USA
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