Korean J Urol.  2013 Apr;54(4):244-248.

A Comparative Study of Laparoendoscopic Single-Site Surgery Versus Conventional Laparoscopy for Upper Urinary Tract Malignancies

Affiliations
  • 1Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. uroham@yuhs.ac
  • 2Department of Urology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

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.

Keyword

Laparoscopy; Nephrectomy; Renal cell carcinoma; Ureteral neoplasms

MeSH Terms

Carcinoma, Renal Cell
Humans
Laparoscopy
Length of Stay
Nephrectomy
Ureteral Neoplasms
Urinary Bladder
Urinary Tract
Urology

Figure

  • FIG. 1 Gross pathologic image of laparoendoscopic single-site surgery nephroureterectomy with bladder cuff excision. Final pathologic result: high-grade transitional cell carcinoma, pT3, located at the right lower ureter with a negative bladder cuff excision margin.


Reference

1. Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol. 2008. 54:1020–1029.
2. Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D, et al. Laparoendoscopic single-site surgery: initial hundred patients. Urology. 2009. 74:805–812.
3. Irwin BH, Rao PP, Stein RJ, Desai MM. Laparoendoscopic single site surgery in urology. Urol Clin North Am. 2009. 36:223–235.
4. Kommu SS, Kaouk JH, Rane A. Laparo-endoscopic single-site surgery: preliminary advances in renal surgery. BJU Int. 2009. 103:1034–1037.
5. Liatsikos E, Kallidonis P, Kyriazis I, Al-Aown A, Stolzenburg JU. Urologic laparoendoscopic single-site surgery. Nat Rev Urol. 2009. 6:654–659.
6. Stolzenburg JU, Kallidonis P, Hellawell G, Do M, Haefner T, Dietel A, et al. Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur Urol. 2009. 56:644–650.
7. Ham WS, Im YJ, Jung HJ, Hong CH, Han WK, Han SW. Initial experience with laparoendoscopic single-site nephrectomy and nephroureterectomy in children. Urology. 2011. 77:1204–1208.
8. Jeong BC, Park YH, Han DH, Kim HH. Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study. J Endourol. 2009. 23:1957–1960.
9. Park YH, Park JH, Jeong CW, Kim HH. Comparison of laparoendoscopic single-site radical nephrectomy with conventional laparoscopic radical nephrectomy for localized renal-cell carcinoma. J Endourol. 2010. 24:997–1003.
10. Raman JD, Bagrodia A, Cadeddu JA. Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol. 2009. 55:1198–1204.
11. Tugcu V, Ilbey YO, Mutlu B, Tasci AI. Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol. 2010. 24:1315–1320.
12. Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, et al. Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol. 2011. 59:26–45.
13. Rassweiler JJ. Is LESS/NOTES really more? Eur Urol. 2011. 59:46–48.
14. Han WK, Park YH, Jeon HG, Jeong W, Rha KH, Choi H, et al. The feasibility of laparoendoscopic single-site nephrectomy: initial experience using home-made single-port device. Urology. 2010. 76:862–865.
15. Jeon HG, Jeong W, Oh CK, Lorenzo EI, Ham WS, Rha KH, et al. Initial experience with 50 laparoendoscopic single site surgeries using a homemade, single port device at a single center. J Urol. 2010. 183:1866–1871.
16. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009. 250:187–196.
17. Raybourn JH 3rd, Rane A, Sundaram CP. Laparoendoscopic single-site surgery for nephrectomy as a feasible alternative to traditional laparoscopy. Urology. 2010. 75:100–103.
18. Seo IY, Lee JW, Rim JS. Laparoendoscopic single-site radical nephrectomy: a comparison with conventional laparoscopy. J Endourol. 2011. 25:465–469.
19. Irwin BH, Cadeddu JA, Tracy CR, Kim FJ, Molina WR, Rane A, et al. Complications and conversions of upper tract urological laparoendoscopic single-site surgery (LESS): multicentre experience: results from the NOTES Working Group. BJU Int. 2011. 107:1284–1289.
20. Lee JY, Kim SJ, Moon HS, Kim YT, Lee TY, Park SY. Initial experience of laparoendoscopic single-site nephroureterectomy with bladder cuff excision for upper urinary tract urothelial carcinoma performed by a single surgeon. J Endourol. 2011. 25:1763–1768.
21. Park YH, Park SY, Kim HH. Laparoendoscopic single-site nephroureterectomy with bladder cuff excision for upper urinary tract transitional-cell carcinoma: technical details based on oncologic principles. J Endourol. 2010. 24:563–566.
Full Text Links
  • KJU
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr