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Re: Laparoendoscopic Single-Site Surgery Versus Standard Laparoscopic Simple Nephrectomy: A Prospective Randomized Study
98
LAPAROSCOPY/NEW TECHNOLOGY
compared with 38 patients who were undergoing conventional laparoscopic radical nephrectomy. The matching process accounted for sex, age, operative side, and tumor size. Results: No significant differences were observed in mean operative time (190.8 vs 172.4 min, P ⫽ 0.249), estimated blood loss (143.2 vs 199.5 mL, P ⫽ 0.235), and complication rate (15.8% vs 21.1 %, P ⫽ 0.635) between the LESS and conventional laparoscopy groups. Postoperative hospital stay after LESS radical nephrectomy was 2.7 (2– 4) days, compared with 3.9 (3–7) days in the conventional laparoscopy group (P ⬍ 0.001). Postoperative pain, as measured by visual analog scale at postoperative day 1 (4.7 vs 5.8 points, P ⫽ 0.001), 2 (3.4 vs 4.6 points, P ⬍ 0.001), and 3 (2.7 vs 4.0 points, P ⫽ 0.008) was significantly lower in the LESS group. Conclusion: LESS radical nephrectomy is a feasible and safe surgical option for localized RCC that demonstrates improved cosmetic outcomes and the additional benefits of decreased postoperative pain and decreased hospital stay.
Re: Laparoendoscopic Single-Site Surgery Versus Standard Laparoscopic Simple Nephrectomy: A Prospective Randomized Study V. Tugcu, Y. O. Ilbey, B. Mutlu and A. I. Tasci Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey J Endourol 2010; 24: 1315–1320.
Background and Purpose: Laparoendoscopic single-site surgery (LESS), an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential morbidity associated with multiple incisions, has been developed recently. Our aim was to compare LESS simple nephrectomy (LESS-SN) and conventional transperitoneal laparoscopic simple nephrectomy (CTL-SN). Patients and Methods: In this randomized study that was conducted between December 2008 and September 2009, 27 patients who needed simple nephrectomy were randomized to either LESS-SN or CTL-SN. All procedures in both groups were performed by the first author, who is experienced in laparoscopic surgery. Patient characteristics, perioperative details, and time to return to work were recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. Results: There was no difference in median operative time (117.5 vs 114 min, P ⫽ 0.52), blood loss (50.71 vs 47.15 mL, P ⫽ 0.60), transfusion rates (0% for both), and hospitalization time (2.07 vs 2.11 days, P ⫽ 0.74) between the LESS-SN and CTL-SN groups. Time to return to normal activities was shorter in the LESS-SN group compared with the CTL-SN group (10.7 vs 13.5 days, P ⫽ 0.001). Both the visual analogue scale and the postoperative use of analgesics were significantly lower during postoperative days 1, 2, and 3 in patients who underwent LESS-SN, compared with patients who underwent CTL-SN. There were no intraoperative or postoperative complications in both groups. Compared with CTL-SN, LESS-SN was more expensive, but all patients undergoing LESS-SN were very pleased with the cosmetic outcome (no visible scars). Conclusion: The early experience described in this study suggests that LESS-SN is a safe and effective alternative to CTL-SN that provides surgeons with a minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus; however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain, recovery, or cosmesis. Editorial Comment: Certainly the data emerging on LESS surgery are rapidly evolving. Although the initial studies that I have highlighted previously in this section demonstrated no significant advantages for LESS compared to conventional laparoscopy, these second generation studies suggest otherwise. The study by Park et al, a case matched radical nephrectomy series, and the study by Tugcu et al, a prospective randomized simple nephrectomy series, demonstrate that the LESS technique is associated with less postoperative pain as determined by visual analogue scale. The series of Park et al was also associated with a shorter hospital stay, while that of Tugcu et al demonstrated a quicker return to normal activities for LESS cases. I remain convinced that for select patients, especially those with a benign diagnosis, a LESS approach is feasible and reasonable. Jeffrey A. Cadeddu, M.D.
LAPAROSCOPY/NEW TECHNOLOGY
compared with 38 patients who were undergoing conventional laparoscopic radical nephrectomy. The matching process accounted for sex, age, operative side, and tumor size. Results: No significant differences were observed in mean operative time (190.8 vs 172.4 min, P ⫽ 0.249), estimated blood loss (143.2 vs 199.5 mL, P ⫽ 0.235), and complication rate (15.8% vs 21.1 %, P ⫽ 0.635) between the LESS and conventional laparoscopy groups. Postoperative hospital stay after LESS radical nephrectomy was 2.7 (2– 4) days, compared with 3.9 (3–7) days in the conventional laparoscopy group (P ⬍ 0.001). Postoperative pain, as measured by visual analog scale at postoperative day 1 (4.7 vs 5.8 points, P ⫽ 0.001), 2 (3.4 vs 4.6 points, P ⬍ 0.001), and 3 (2.7 vs 4.0 points, P ⫽ 0.008) was significantly lower in the LESS group. Conclusion: LESS radical nephrectomy is a feasible and safe surgical option for localized RCC that demonstrates improved cosmetic outcomes and the additional benefits of decreased postoperative pain and decreased hospital stay.
Re: Laparoendoscopic Single-Site Surgery Versus Standard Laparoscopic Simple Nephrectomy: A Prospective Randomized Study V. Tugcu, Y. O. Ilbey, B. Mutlu and A. I. Tasci Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey J Endourol 2010; 24: 1315–1320.
Background and Purpose: Laparoendoscopic single-site surgery (LESS), an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential morbidity associated with multiple incisions, has been developed recently. Our aim was to compare LESS simple nephrectomy (LESS-SN) and conventional transperitoneal laparoscopic simple nephrectomy (CTL-SN). Patients and Methods: In this randomized study that was conducted between December 2008 and September 2009, 27 patients who needed simple nephrectomy were randomized to either LESS-SN or CTL-SN. All procedures in both groups were performed by the first author, who is experienced in laparoscopic surgery. Patient characteristics, perioperative details, and time to return to work were recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. Results: There was no difference in median operative time (117.5 vs 114 min, P ⫽ 0.52), blood loss (50.71 vs 47.15 mL, P ⫽ 0.60), transfusion rates (0% for both), and hospitalization time (2.07 vs 2.11 days, P ⫽ 0.74) between the LESS-SN and CTL-SN groups. Time to return to normal activities was shorter in the LESS-SN group compared with the CTL-SN group (10.7 vs 13.5 days, P ⫽ 0.001). Both the visual analogue scale and the postoperative use of analgesics were significantly lower during postoperative days 1, 2, and 3 in patients who underwent LESS-SN, compared with patients who underwent CTL-SN. There were no intraoperative or postoperative complications in both groups. Compared with CTL-SN, LESS-SN was more expensive, but all patients undergoing LESS-SN were very pleased with the cosmetic outcome (no visible scars). Conclusion: The early experience described in this study suggests that LESS-SN is a safe and effective alternative to CTL-SN that provides surgeons with a minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus; however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain, recovery, or cosmesis. Editorial Comment: Certainly the data emerging on LESS surgery are rapidly evolving. Although the initial studies that I have highlighted previously in this section demonstrated no significant advantages for LESS compared to conventional laparoscopy, these second generation studies suggest otherwise. The study by Park et al, a case matched radical nephrectomy series, and the study by Tugcu et al, a prospective randomized simple nephrectomy series, demonstrate that the LESS technique is associated with less postoperative pain as determined by visual analogue scale. The series of Park et al was also associated with a shorter hospital stay, while that of Tugcu et al demonstrated a quicker return to normal activities for LESS cases. I remain convinced that for select patients, especially those with a benign diagnosis, a LESS approach is feasible and reasonable. Jeffrey A. Cadeddu, M.D.