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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: 0.5] [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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Ischemia Techniques in Nephron-sparing Surgery: A Systematic Review and Meta-Analysis of Surgical, Oncological, and Functional Outcomes. Eur Urol 2018; 75:477-491. [PMID: 30327272 DOI: 10.1016/j.eururo.2018.10.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/01/2018] [Indexed: 01/20/2023]
Abstract
CONTEXT The optimal ischemia technique at partial nephrectomy (PN) for renal masses is yet to be determined. OBJECTIVE To summarize and analyze the current evidence about surgical, oncological, and functional outcomes after different ischemia techniques (cold, warm, and zero ischemia) at PN. EVIDENCE ACQUISITION A computerized systematic literature search was performed by using PubMed (MEDLINE) and Science Direct. Identification and selection of the studies were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. Outcomes of interest were estimated blood loss (EBL), overall complications, positive surgical margins, local tumor recurrence, and renal function preservation. Meta-analysis and forest-plot diagrams were performed. Overall pooled estimates, together with 95% confidence intervals (CIs), of the incidence of all parameters were obtained using a random effect model (RE-Model) on the log transformed means (MLN), proportion, or standardized mean change, as deemed appropriate. EVIDENCE SYNTHESIS One hundred and fifty-six studies were included. No clinically meaningful differences were found in terms of EBL after cold (mean: 215.5; 95% CI: 154.2-276.8m), warm (mean: 201.8; 95% CI: 175.0-228.7ml), or zero (mean: 261.2; 95% CI: 171.0-351.3ml) ischemia technique. Overall, postoperative complications were recorded in 14.1% (95% CI: 6.7-27.4), 11.1% (95% CI: 10.0-12.3), and 9.7% (95% CI: 7.7-12.2) of patients after cold, warm, and zero ischemia (p<0.01), respectively. Positive surgical margins were recorded in 4.8% (95% CI: 1.9-10.9), 4.0% (95% CI: 3.4-4.8), and 5.6% (95% CI: 3.1-9.8) of patients after cold, warm, and zero ischemia (p<0.01), respectively. Local recurrence was recorded in 3.2% (95% CI: 1.9-5.2) and 3.1% (95% CI: 0.7-11.5) of patients after warm and zero ischemia (p<0.01), respectively. The log2 of estimated glomerular filtration ratio mean changes were-1.37 (95% CI:-3.42 to 0.68),-1.00 (-2.04 to 0.03), and-0.71 (-1.15 to-0.27) ml/min after cold, warm, and zero ischemia, respectively. Low level of evidence, retrospective nature of most of included studies, a high risk of selection bias, and heterogeneity within included studies limited the overall quality of the analysis. CONCLUSIONS The effect of ischemia technique at PN is still debatable and subject to confounding by several factors, namely, patients' selection criteria, surgical technique used, and percentage of functional parenchyma spared during surgery. These confounders bias available evidence and were addressed by only a small part of available studies. Unfortunately, the overall quality of literature evidences and the high risk of selection bias limit the possibility of any causal interpretation about the relationship between the ischemia technique used and surgical, oncological, or functional outcomes. Thus, none of the available ischemia technique could be recommended over the other. PATIENT SUMMARY The present analysis shows that none of the available ischemia techniques, namely, cold, warm, or zero ischemia, is universally superior to the others, and other factors play a role in the surgical outcome.
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Choo SH, Lee SW, Sung HH, Jeong BC, Han DH. Clinical Usefulness of a Self-Retaining Internal Organ Retractor for Laparoendoscopic Single-Site Adrenalectomy. J Laparoendosc Adv Surg Tech A 2018; 29:379-384. [PMID: 30289346 DOI: 10.1089/lap.2018.0414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Although laparoendoscopic single-site adrenalectomy (LESS-A) is feasible, it is still considered as a challenging procedure because of technical limitations. Making an optimal retraction is one of major obstacles in LESS-A, and it sometimes requires additional ports or needlescopic devices. Internal organ retractor (IOR) is a novel retraction device that is applied intracorporeally without additional port. In this study, we investigated the clinical usefulness of IOR in LESS-A. MATERIALS AND METHODS Medical records of 73 consecutive patients who underwent LESS-A from March 2009 to December 2014 were reviewed. Twenty-two patients underwent LESS-A with IOR and 51 patients without IOR. RESULTS Mean age, body mass index, tumor size, operation time, estimated blood loss, and hospital stay were not significantly different between two groups. In IOR group, median number of applied IOR was 2.0 (1.0-3.0) per single operation. Mean time for application and removal was 80.0 and 46.5 seconds for a single IOR, respectively. There were no complications related to the IOR. In without IOR group, there were nine cases that needed needlescopic trocars, six cases that needed 5 mm or larger trocars, and one case that was converted to hand-assisted laparoscopy. However, we did not use any needlescopic instrument or additional trocar in IOR group. There was no case of open conversion in both groups. CONCLUSION LESS-A could be done effectively and safely using IOR. IOR system maintained optimal retraction throughout the operation. Its application and removal are intuitive and take only a few minutes. We think IOR system is an attractive retraction method in LESS-A.
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Affiliation(s)
- Seol Ho Choo
- 1 Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Sin Woo Lee
- 2 Department of Urology, Gyeongsang National University Hospital, Jinju, Korea
| | - Hyun Hwan Sung
- 3 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- 3 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Hyun Han
- 3 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abdel-Karim AM, El Tayeb MM, Yahia E, Elmissiry M, Hassouna M, Elsalmy S. Evaluation of the Role of Laparoendoscopic Single-Site Surgery vs Minilaparoscopy for Treatment of Upper Urinary Tract Pathologies: Prospective Randomized Comparative Study. J Endourol 2018; 31:1237-1242. [PMID: 29020831 DOI: 10.1089/end.2017.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. PATIENTS AND METHODS Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively (p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively (p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively (p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively (p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively (p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. CONCLUSION Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome.
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Affiliation(s)
- Aly M Abdel-Karim
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Marawan M El Tayeb
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Elsaid Yahia
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mostafa Elmissiry
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mohamed Hassouna
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Salah Elsalmy
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
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Abstract
BACKGROUND The rising incidence of renal cell carcinoma, its more frequent early detection (stage T1a) and the increasing prevalence of chronic renal failure with higher morbidity and shorter life expectancy underscore the need for multimodal focal nephron-sparing therapy. DISCUSSION During the past decade, the gold standard shifted from radical to partial nephrectomy. Depending on the surgeon's experience, the patient's constitution and the tumor's location, the intervention can be performed laparoscopically with the corresponding advantages of lower invasiveness. A treatment alternative can be advantageous for selected patients with high morbidity and/or an increased risk of complications associated with anesthesia or surgery. Corresponding risk stratification necessitates previous confirmation of the small renal mass (cT1a) by histological examination of biopsy samples. Active surveillance represents a controlled delay in the initiation of treatment. RESULTS Percutaneous radiofrequency ablation (RFA) and laparoscopic cryoablation are currently the most common treatment alternatives, although there are limitations particularly for renal tumors located centrally near the hilum. More recent ablation procedures such as high intensity focused ultrasound (HIFU), irreversible electroporation, microwave ablation, percutaneous stereotactic ablative radiotherapy and high-dose brachytherapy have high potential in some cases but are currently regarded as experimental for the treatment of renal cell carcinoma.
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Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes. World J Urol 2017; 35:1721-1728. [DOI: 10.1007/s00345-017-2062-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/09/2017] [Indexed: 01/09/2023] Open
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Kunath F, Schmidt S, Krabbe L, Miernik A, Dahm P, Cleves A, Walther M, Kroeger N. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev 2017; 5:CD012045. [PMID: 28485814 PMCID: PMC6481491 DOI: 10.1002/14651858.cd012045.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Partial nephrectomy and radical nephrectomy are the relevant surgical therapy options for localised renal cell carcinoma. However, debate regarding the effects of these surgical approaches continues and it is important to identify and summarise high-quality studies to make surgical treatment recommendations. OBJECTIVES To assess the effects of partial nephrectomy compared with radical nephrectomy for clinically localised renal cell carcinoma. SEARCH METHODS We searched CENTRAL, MEDLINE, PubMed, Embase, Web of Science, BIOSIS, LILACS, Scopus, two trial registries and abstracts from three major conferences to 24 February 2017, together with reference lists; and contacted selected experts in the field. SELECTION CRITERIA We included a randomised controlled trial comparing partial and radical nephrectomy for participants with small renal masses. DATA COLLECTION AND ANALYSIS One review author screened all of the titles and abstracts; only citations that were clearly irrelevant were excluded at this stage. Next, two review authors independently assessed full-text reports, identified relevant studies, evaluated the eligibility of the studies for inclusion, assessed trial quality and extracted data. The update of the literature search was performed by two independent review authors. We used Review Manager 5 for data synthesis and data analyses. MAIN RESULTS We identified one randomised controlled trial including 541 participants that compared partial nephrectomy to radical nephrectomy. The median follow-up was 9.3 years.Based on low quality evidence, we found that time-to-death of any cause was decreased using partial nephrectomy (HR 1.50, 95% CI 1.03 to 2.18). This corresponds to 79 more deaths (5 more to 173 more) per 1000. Also based on low quality evidence, we found no difference in serious adverse events (RR 2.04, 95% CI 0.19 to 22.34). Findings are consistent with 4 more surgery-related deaths (3 fewer to 78 more) per 1000.Based on low quality evidence, we found no difference in time-to-recurrence (HR 1.37, 95% CI 0.58 to 3.24). This corresponds to 12 more recurrences (14 fewer to 70 more) per 1000. Due to the nature of reporting, we were unable to analyse overall rates for immediate and long-term adverse events. We found no evidence on haemodialysis or quality of life.Reasons for downgrading related to study limitations (lack of blinding, cross-over), imprecision and indirectness (a substantial proportion of patients were ultimately found not to have a malignant tumour). Based on the finding of a single trial, we were unable to conduct any subgroup or sensitivity analyses. AUTHORS' CONCLUSIONS Partial nephrectomy may be associated with a decreased time-to-death of any cause. With regards to surgery-related mortality, cancer-specific survival and time-to-recurrence, partial nephrectomy appears to result in little to no difference.
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Affiliation(s)
- Frank Kunath
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
| | | | - Laura‐Maria Krabbe
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- University of Muenster Medical CenterDepartment of UrologyAlbert‐Schweitzer Campus 1, GB A1MuensterNRWGermany48149
| | - Arkadiusz Miernik
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- Medical University Centre FreiburgDepartment of UrologyHugstetterstrasse 55FreiburgBaden‐WürttembergGermany79106
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
| | - Anne Cleves
- Cardiff University Library ServicesVelindre NHS TrustVelindre Cancer CentreCardiffWalesUKCF14 2TL
| | | | - Nils Kroeger
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- University Hospital GreifswaldDepartment of Urology17489 GreifswaldGreifswaldGermany
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Redondo C, Esquinas C, Meilán E, García-Tello A, Arance I, Angulo JC. Comparative study of hybrid laparoendoscopic single-site (LESS) partial nephrectomy and conventional multiport laparoscopy. Actas Urol Esp 2017; 41:242-248. [PMID: 27825746 DOI: 10.1016/j.acuro.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. MATERIAL AND METHOD Hybrid LESS technique with auxiliary 3.5mm trocar (n=20) was compared with conventional multiport laparoscopy (n=26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. RESULTS Follow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P=0.09) and benign histology (P=0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P=0.006) and hospital stay (P=0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. CONCLUSIONS Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes.
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Affiliation(s)
- C Redondo
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - C Esquinas
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - E Meilán
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - A García-Tello
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - I Arance
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
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Vilaseca A, Musquera M, Nguyen D, Di Paola G, Romeo L, Melnick A, García-Cruz E, Ribal M, Huguet J, Alcaraz A. Changing patterns in the surgical management of renal masses. Actas Urol Esp 2016; 40:148-54. [PMID: 26687094 DOI: 10.1016/j.acuro.2015.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe the temporal trends in surgical techniques for the management of renal masses at a single Spanish academic institution and identify factors associated with partial nephrectomy (PN) decision. MATERIALS AND METHODS A total of 646 patients were treated by surgery for clinically localised renal masses from January 2004 to December 2012 at a tertiary referral center. Surgical techniques included open radical nephrectomy (RN), open PN, laparoscopic RN, and laparoscopic PN. Descriptive statistics were used to compare baseline characteristics and proportions of patients treated by different surgical techniques. Annual trends in the proportion of procedures performed were determined. Adjusted odds ratios (OR) and 95% confidence intervals were calculated to evaluate clinical variables predictive of PN. RESULTS During the 9-year study period, the proportion of PN relative to RN increased from 21% to 55%. With regard to surgical approach, open procedures for both RN and PN decreased gradually in favor of minimally invasive approaches (83% in 2004 to 4% in 2011-2012). While median tumor size did not significantly change over the study period, laparoscopic PN became the most commonly performed kidney procedure in 2011-2012 (49% of all procedures). Clinical variables independently predictive of partial nephrectomy were ASA score, baseline renal function and tumor size (all P<.05). CONCLUSIONS At our academic institution, temporal trends in the management of renal masses have established PN as the most common surgical option. Although PN was increasingly used over the study period, a parallel increase in minimally invasive approaches for RN and PN was seen.
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Komine O, Suzuki H, Watanabe M, Nomura S, Mizutani S, Yoshino M, Chihara N, Mishima K, Oyama R, Uchida E. Single-incision laparoscopic cholecystectomy with an additional needle grasper: a novel technique. J NIPPON MED SCH 2016; 82:43-9. [PMID: 25797875 DOI: 10.1272/jnms.82.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Single-incision laparoscopic surgery has gained increasing attention due to its potential to improve the benefits of laparoscopic surgery. However, the technique remains technically challenging for most surgeons. We developed a new technique utilizing a needle grasper held in the surgeon's left hand as an alternative to conventional single-incision laparoscopic cholecystectomy (SILC). PATIENTS AND METHODS From August 2011 through May 2013, 29 patients at Nippon Medical School Musashi Kosugi Hospital, with gallbladder stones or polyps underwent single-incision laparoscopic cholecystectomy (SILC) with an additional needle grasper that was held in the surgeon's left hand (SILCAN) and introduced in the right subcostal region without a trocar. We analyzed intraoperative and postoperative outcomes of 29 patients for whom SILCAN was performed and retrospectively compared these outcomes to those of 32 patients who underwent conventional 4-port laparoscopic cholecystectomy (CLC) from January 2011 through May 2013. RESULTS No differences in patient characteristics or intraoperative/postoperative outcomes were observed between the groups. None of the patients in either group required conversion to an open procedure or additional ports. In the SILCAN group, no patients had complications within the first 4 weeks after surgery, with the exception of 1 patient with severe chronic cholecystitis in whom bile duct stenosis developed due to inadvertent clipping of the common hepatic duct. The frequency of postoperative analgesic use was similar in both groups, although none of the patients in the SILCAN group received analgesics for pain from the small, inconspicuous wound in the right subcostal region. CONCLUSIONS SILCAN is a safe and feasible alternative to SILC which does not compromise the qualities of CLC. It is less technically challenging, and postoperative pain and cosmesis are comparable to those of conventional SILC.
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Affiliation(s)
- Osamu Komine
- Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital
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Feng L, Song J, Wu M, Tian Y, Zhang D. Retroperitoneal Laparoendoscopic Single-Incision Radical Nephrectomy Without Special Platforms: A Single-Center Initial Experience. J Laparoendosc Adv Surg Tech A 2016; 26:203-8. [PMID: 26859099 DOI: 10.1089/lap.2015.0483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Lang Feng
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| | - Jian Song
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| | - Menghua Wu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| | - Daoxin Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
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Kim DK, Yoon YE, Han WK, Rha KH. Roles of NOTES and LESS in management of small renal masses. Int J Surg 2015; 36:574-582. [PMID: 26607854 DOI: 10.1016/j.ijsu.2015.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/27/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Over the last 2 decades, open surgery has been largely displaced by laparoscopic surgery for the treatment of renal masses. Recently, minimally invasive surgical techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), have been developed for such purpose. METHODS In the present literature review, the current status of treatment for small renal masses was investigated. The advantages and disadvantages of LESS and NOTES are presented to confirm the feasibility and reproducibility of these techniques. RESULTS LESS significantly reduces pain and offers excellent cosmetic outcomes with comparable oncological and perioperative results, and NOTES offers the potential for surgery by various approach without any transcutaneous abdominal incision in management of small renal masses. CONCLUSION When the technical limitations are overcome, clinical application of LESS and NOTES is expected to increase. Further prospective and comparative studies are needed to clarify the application of these new techniques.
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Affiliation(s)
- Dae Keun Kim
- Department of Urology, CHA Gangnam Hospital, CHA University, CHA Medical School, Seoul, Republic of Korea; Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul, Republic of Korea.
| | - Young Eun Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
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Schoenthaler M, Miernik A, Offner K, Karcz WK, Hauschke D, Sevcenco S, Kuehhas FE, Bach C, Buchholz N, Wilhelm K. The cumulative analgesic consumption score (CACS): evaluation of a new score to describe postsurgical analgesic consumption as a surrogate parameter for postoperative pain and invasiveness of surgical procedures. Int Braz J Urol 2015; 40:330-6. [PMID: 25010299 DOI: 10.1590/s1677-5538.ibju.2014.03.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/24/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To validate and evaluate the applicability of a new score to describe postsurgical analgesic consumption in urological and surgical patients across different categories of pain medications and the invasiveness of medical interventions. MATERIALS AND METHODS The cumulative analgesic consumption score (CACS) was determined for two cohorts of patients split into three groups with surgeries involving clinically distinct levels of invasiveness (n = 2 x 60). Nonparametric statistical analyses were performed to determine differences between the CACS among the different groups and to assess the correlation between CACS and numeric rating scale (NRS) values for pain intensity. RESULTS The score was determined for postoperative days 1 and 2 and revealed median scores of 0 (0-11), 3 (0-22) and 10 (6-17) for UA (urological patients from group A), UB (group B) and UC (group C), respectively, and 4 (0-20), 8 (0-38) and 17 (7-68) for SA (surgical patients from group A, SB (group B) and SC (group C), respectively. CACS enabled reliable differentiation between groups involving different levels of invasiveness (p < 0.001). CACS and peak NRS values showed variable degrees of correlation, as expressed by levels of significance ranging from p < 0.001 to p = 0.34 (NS). CONCLUSIONS The CACS is a valid and easily applicable tool to describe postsurgical analgesic consumption in urological and surgical patients. It can be used as a surrogate parameter to assess postsurgical pain and the invasiveness of surgical procedures. These aspects may be measured to compare surgical procedures, in both clinical trials and clinical practice settings.
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Affiliation(s)
- Martin Schoenthaler
- Department of Urology, , University Medical Center Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- 1Department of Urology, , University Medical Center Freiburg, Freiburg, Germany
| | - Klaus Offner
- Department of Anesthesiology, , University Medical Center Freiburg, Freiburg, Germany
| | - Wojciech Konrad Karcz
- Department of General and Visceral Surgery, , University Medical Center Freiburg, Freiburg, Germany
| | - Dieter Hauschke
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany
| | - Sabina Sevcenco
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Christian Bach
- Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Noor Buchholz
- Department of Urology, The Royal London Hospital, Bartshealth NHS Trust, London, United Kingdom
| | - Konrad Wilhelm
- Department of Urology, , University Medical Center Freiburg, Freiburg, Germany
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Lin CH, Liu QZ, Zhang ZF, Li GL, Shi L, Gao ZL. Initial experience of percutaneous nephrolithotomy combined with retroperitoneal laparoendoscopic single-site partial nephrectomy in one-stage treatment of homolateral renal diseases. Ren Fail 2015; 37:840-4. [PMID: 25707525 DOI: 10.3109/0886022x.2015.1015392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study investigated the feasibility of percutaneous nephrolithotomy (PCNL) combined with retroperitoneal laparoendoscopic single-site partial nephrectomy (LESS-PN) in one-stage treatment of homolateral renal calculi and tumors. Between October 2010 and July 2014 one-stage PCNL combined LESS-PN surgery was performed in 23 patients with homolateral renal calculi and tumors. Patients included 17 male and 8 female, ranged from 31 to 66 years old with a median age of 42.7. Operative parameters and occurrence rate of complications were recorded. In all cases renal tumors were successfully removed without converting to open surgery. One-stage clearance rate for renal calculi was 21/23 (91.3%), leaving two cases for second-stage operation of flexible ureteroscope lithotomy. The operation time was 95-186 min; average 128 min. Intraoperative blood loss was 40-200 mL; average 130 mL. Median warm ischemia time was 23.8 ± 9.5 min. There were no serious post-operative complications such as massive hemorrhage or urine leakage. Length of stay was 5-7 days, average 6 days. There was no recurrence of renal calculus, renal tumors or ureterostenosis and kidney functions were normal. In conclusion, with good practice, one-stage combined operation of PCNL and retroperitoneal LESS-PN in removing homolateral renal tumors and calculi was safe, feasible and would potentially reduce the operative trauma.
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Affiliation(s)
- Chun-hua Lin
- a Medical College, Shandong University , Jinan , Shandong , P.R. China and
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Castellucci R, Cindolo L, Alvaréz-Maestro M, Giusti G, Berardinelli F, Pellegrini F, Schips L. Single-site laparoscopic partial nephrectomy: Where are we going? World J Clin Urol 2014; 3:358-363. [DOI: 10.5410/wjcu.v3.i3.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/23/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To review an evolution of laparoscopic surgery, there has been a growing interest in laparoendoscopic single-site surgery (LESS).
METHODS: A comprehensive electronic literature search was conducted using PubMed database to identify all publications relating to LESS-partial nephrectomy (PN). The research includes articles published from April 2008 to January 2014. We focused our attention only on articles in which were cited the single-site surgical technique (laparoscopic and robotic), tumour stage and grade, mean tumour size, intraoperative variables, blood loss and transfusion rate, length of post-operative stay and complication rates, Clavien classification, positive of surgical margins, pain assessment at discharge.
RESULTS: A total of 9 studies were collected with 221 patients included. The mean patients age was 62 years. The mean tumor size was 2.35 cm with a mean operative time of 181 min (range 111-270 min) and 58.3% were done by robot. The mean ischemia time was 23.6 min. The 25.8% of patients underwent an unclamp LESS-PN. Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d. The rate of severe post-operative complications (≥ Clavien grade III) was 5.4%. Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery. Regarding oncologic outcomes, surgical margins were positive 4% of patients (9/221), no distant or port-site metastases were recorded.
CONCLUSION: LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain, shorter median hospital stay, shorter recovery time, and better cosmetic satisfaction without compromising surgical and oncological safety.
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16
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Kopp RP, Mehrazin R, Palazzi KL, Liss MA, Jabaji R, Mirheydar HS, Lee HJ, Patel N, Elkhoury F, Patterson AL, Derweesh IH. Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score. BJU Int 2014; 114:708-18. [DOI: 10.1111/bju.12580] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Ryan P. Kopp
- Department of Urology; UC San Diego Health System; La Jolla CA USA
| | - Reza Mehrazin
- Department of Urology; University of Tennessee Health Science Center; Memphis TN USA
| | | | - Michael A. Liss
- Department of Urology; UC San Diego Health System; La Jolla CA USA
| | - Ramzi Jabaji
- Department of Urology; UC San Diego Health System; La Jolla CA USA
| | | | - Hak J. Lee
- Department of Urology; UC San Diego Health System; La Jolla CA USA
| | - Nishant Patel
- Department of Urology; UC San Diego Health System; La Jolla CA USA
| | - Fuad Elkhoury
- Department of Urology; UC San Diego Health System; La Jolla CA USA
| | - Anthony L. Patterson
- Department of Urology; University of Tennessee Health Science Center; Memphis TN USA
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Bansal D, Cost NG, Bean CM, Noh PH. Pediatric laparo-endoscopic single site partial nephrectomy: feasibility in infants and small children for upper urinary tract duplication anomalies. J Pediatr Urol 2014; 10:859-63. [PMID: 24598458 DOI: 10.1016/j.jpurol.2014.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/24/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the feasibility and outcomes of laparo-endoscopic single site (LESS) partial nephrectomy (PN) in infants and small children for upper urinary tract duplication anomalies. MATERIALS AND METHODS The medical records of all patients undergoing LESS PN at a single pediatric institution were retrospectively reviewed for patient demographics, perioperative details, and outcomes. A cystoscopy was initially performed to place an externalized catheter into the ureter of the ipsilateral normal renal moiety. An Olympus TriPort, an Olympus Endoeye flexible tip laparoscope, standard 3- or 5-mm instrumentation, and a LigaSure Blunt were utilized. RESULTS Four children (two boys, two girls) underwent LESS PN. Three patients underwent upper pole PN and one underwent lower pole PN. All procedures were performed for poorly functioning obstructed renal moieties (one ureterocele, one ureteropelvic junction obstruction and vesicoureteral reflux, and two ectopic ureters). Median age was 6.2 months (range 2.5-16.4 months). Median weight was 7.7 kg (range 6.1-12.6 kg). Median operative time was 126 min (range 97-180 min). No patient received inpatient postoperative narcotics. Median follow-up was 9.9 months (range 6.2-19.1 months). No postoperative complications were noted. Postoperative renal ultrasound demonstrated successful resection in all patients. CONCLUSIONS LESS PN is technically feasible, safe, and effective for upper urinary tract duplication anomalies in infants and small children.
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Affiliation(s)
- D Bansal
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH, USA
| | - N G Cost
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH, USA
| | - C M Bean
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH, USA
| | - P H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH, USA.
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Shin TY, Lim SK, Komninos C, Kim DW, Han WK, Hong SJ, Jung BH, Rha KH. Laparoendoscopic single-site (LESS) robot-assisted partial nephrectomy (RAPN) reduces postoperative wound pain without a rise in complication rates. BJU Int 2014; 114:555-61. [DOI: 10.1111/bju.12783] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tae Young Shin
- Department of Urology; Chuncheon Sacred Hospital; Hallym University College of Medecine; Chuncheon Korea
| | - Sey Kiat Lim
- Department of Urology; Changi General Hospital; Singapore
| | - Christos Komninos
- Department of Urology; General Hospital of Nikaia ‘St. Panteleimon’; Athens Greece
| | - Dong Wook Kim
- Biostatistics Collaboration Unit; Yonsei University College of Medicine; Seoul Korea
| | - Woong Kyu Han
- Department of Urology; Urological Science Institute; Seoul Korea
| | - Sung Jun Hong
- Department of Urology; Urological Science Institute; Seoul Korea
| | - Byung Ha Jung
- Department of Urology; Urological Science Institute; Seoul Korea
| | - Koon Ho Rha
- Department of Urology; Urological Science Institute; Seoul Korea
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Laparoendoscopic Single-site Nephrectomy Compared with Conventional Laparoscopic Nephrectomy: A 5-year, Single-surgeon Experience. Eur Urol 2013; 64:412-8. [DOI: 10.1016/j.eururo.2013.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/09/2013] [Indexed: 11/21/2022]
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Kallidonis P, Kontogiannis S, Kyriazis I, Georgiopoulos I, Al-Aown A, Stolzenburg JU, Liatsikos E. Laparoendoscopic single-site surgery in kidney surgery: clinical experience and future perspectives. Curr Urol Rep 2013; 14:496-505. [PMID: 23740382 DOI: 10.1007/s11934-013-0346-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Laparoscopic surgery of the upper urinary tract has reduced the morbidity related to large abdominal incisions and has resulted in significant advantages over open surgery. Nevertheless, the pursuit for even more minimally invasive alternatives to laparoscopy has led to the concept of scarless surgery and the approach of laparoendoscopic single-site surgery (LESS). LESS is currently a feasible approach for the majority of kidney surgical procedures, and there is intense debate regarding its efficiency and advantages. In the present review of the literature, the current status of upper urinary LESS and its advantages and disadvantages, as well the technological and technical evolution, are presented.
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Merseburger AS, Herrmann TRW, Shariat SF, Kyriazis I, Nagele U, Traxer O, Liatsikos EN. EAU guidelines on robotic and single-site surgery in urology. Eur Urol 2013; 64:277-91. [PMID: 23764016 DOI: 10.1016/j.eururo.2013.05.034] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/15/2013] [Indexed: 12/19/2022]
Abstract
CONTEXT This is a short version of the European Association of Urology (EAU) guidelines on robotic and single-site surgery in urology, as created in 2013 by the EAU Guidelines Office Panel on Urological Technologies. OBJECTIVE To evaluate current evidence regarding robotic and single-site surgery in urology and to provide clinical recommendations. EVIDENCE ACQUISITION A comprehensive online systematic search of the literature according to Cochrane recommendations was performed in July 2012, identifying data from 1990 to 2012 regarding robotic and single-site surgery in urology. EVIDENCE SYNTHESIS There is a lack of high-quality data on both robotic and single-site surgery for most upper and lower urinary tract operations. Mature evidence including midterm follow-up data exists only for robot-assisted radical prostatectomy. In the absence of high-quality data, the guidelines panel's recommendations were based mostly on the review of low-level evidence and expert opinions. CONCLUSIONS Robot-assisted urologic surgery is an emerging and safe technology for most urologic operations. Further documentation including long-term oncologic and functional outcomes is deemed necessary before definite conclusions can be drawn regarding the superiority or not of robotic assistance compared with the conventional laparoscopic and open approaches. Laparoendoscopic single-site surgery is a novel laparoscopic technique providing a potentially superior cosmetic outcome over conventional laparoscopy. Nevertheless, further advantages offered by this technology are still under discussion and not yet proven. Due to the technically demanding character of the single-site approach, only experienced laparoscopic surgeons should attempt this technique in clinical settings. PATIENT SUMMARY This work represents the shortened version of the 2013 European Association of Urology guidelines on robotic and single-site surgery. The authors systematically evaluated published evidence in these fields and concluded that robotic assisted surgery is possible and safe for most urologic operations. Whilst laparoendoscopic single-site surgery is performed using the fewest incisions, the balance between risk and benefit is currently unclear. The evidence to support the conclusions in this guideline was generally poor, but best for robotic assisted radical prostatectomy. As such, these recommendations were based upon expert opinion, and further high-quality research is needed in this field.
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Affiliation(s)
- Axel S Merseburger
- Department of Urology and Urologic Oncology Medical School of Hanover (MHH), Hanover, Germany.
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Bazzi WM, Stroup SP, Cohen SA, Sisul DM, Liss MA, Masterson JH, Kopp RP, Gudeman SR, Leeflang E, Palazzi KL, Ramamoorthy S, Kane CJ, Horgan S, Derweesh IH. Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model. Urology 2013; 82:84-9. [PMID: 23676357 DOI: 10.1016/j.urology.2013.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/13/2013] [Accepted: 03/05/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the feasibility of porcine transrectal (TR) and transvaginal (TV) hybrid natural orifice transluminal endoscopic surgery (NOTES) partial nephrectomy (PN), as NOTES nephrectomy has recently been performed in the porcine model. MATERIALS AND METHODS A total of 10 female pigs (weight 45 kg) underwent TR (n = 5) or TV (n = 5) NOTES PN. The pneumoperitoneum was created by a periumbilical 12-mm trocar, through which a laparoscope was advanced for intra-abdominal visualization. For TV-NOTES PN, a gastroscope was used to obtain TV peritoneal access. For TR-NOTES PN, a horizontal incision was made 2 cm above the dentate line, and a submucosal tunnel was created in the posterior rectal wall. The gastroscope was advanced through the submucosal tunnel and retroperitoneum to the kidney, and a peritoneal window was created. For both TR- and TV-NOTES PN, the gastroscope was exchanged for the SPIDER Surgical System. Flexible dissecting instruments and hook cautery introduced through the SPIDER Surgical System were used to mobilize the kidney. A harmonic scalpel introduced periumbilically was used to excise a portion of the lower pole. LAPRA-TY-secured sutured renorrhaphy was performed, followed by TR or TV specimen extraction. RESULTS TR- and TV-NOTES PN was successfully performed in all 10 pigs. A comparison of TR- and TV-NOTES PN revealed no significant differences in the mean access time (29.2 vs 29.6 minutes, P = .944), operative time (196.0 vs 183.0 minutes, P = .631), and estimated blood loss (59.0 vs 54.0 mL, P = .861). Necropsy did not demonstrate abdominal injuries. CONCLUSION We have demonstrated proof-of-principle for TR and TV-NOTES PN in swine, with comparable perioperative parameters. Preclinical survival studies are requisite to assess the potential of TR-NOTES as an alternative to TV-NOTES.
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Affiliation(s)
- Wassim M Bazzi
- Department of Surgery, University of California, La Jolla, CA, USA
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