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Minerva Urologica e Nefrologica 2017 Mar 10

DOI: 10.23736/S0393-2249.17.02785-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Comparison of laparoendoscopic single-site (LESS) and multiport laparoscopic radical nephrectomy for clinical T1b and T2a renal masses

Abd-el R. HASSAN 1, Omer A. RAHEEM 1, Sean BERQUIST 1, Alp T. BEKSAC 1, Aaron BLOCH 1, Charles FIELD 1, Hak J. LEE 1, Reza MEHRAZIN 2, Marc HOLDEN 1, Michelle McDONALD 1, Zachary HAMILTON 1, Michael LISS 1, Ithaar H. DERWEESH 1

1 Department of Urology, UC San Diego Health System, La Jolla, CA, USA; 2 Department of Urology, and University of Tennessee Health Science Center, Memphis, TN, USA


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BACKGROUND: To compare outcomes of Laparoendoscopic single-site surgery (LESS) and multiport laparoscopic (MPL) Radical Nephrectomy (RN) for clinical T1b/T2a renal masses, as concerns continue regarding suitability and benefit of LESS for larger renal masses.
METHODS: Retrospective single-surgeon comparison of LESS- and MPL-RN between 7/2005 and 11/2014. 63 patients underwent LESS-RN (44 cT1b/19 cT2a); 133 underwent MPL (83 cT1b/50 cT2a). All patients were managed with a standardized care pathway. Primary outcome was length of hospital stay (LOS). Secondary outcomes included operative time, estimated blood loss (EBL), complications, discharge pain score (visual analog pain, VAP), narcotic requirement (morphine equivalents, MSO4eq).
RESULTS: 130/133 MPL and 62/63 LESS were successfully performed. For MPL and LESS groups: Mean tumor diameter (cm) for cT1b was 5.3 vs. 5.4 (p=0.689); and for cT2a was 8.2 vs. 8.3 (p=0.728); mean OR time (min) was 126.3 vs. 132.7 (p=0.314); mean EBL (mL) was 139.5 vs.127.8 (p=0.49). No significant differences in complications were noted (p=0.781). LESS was associated with significant reductions in LOS (2.14 vs. 2.45 days, p=0.043), discharge VAP (1.3 vs. 2.2, p<0.001), and narcotic use (5.9 vs. 10.7 MSO4eq, p<0.001).
CONCLUSIONS: LESS is comparable to MPL-RN for cT1b and T2a renal tumors in terms of perioperative parameters and may confer benefit with respect to LOS and analgesic requirement.


KEY WORDS: Carcinoma - Renal cell - Laparoscopy - Radical nephrectomy - Laparoendoscopic single-site surgery - Stage I, Stage II

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iderweesh@gmail.com