Clinical application of intra-abdominal exposure instruments in laparoendoscopic single-port nephrectomy

Abstract

Objective To evaluate the feasibility and clinical efficacy of intra-abdominal exposure instruments in laparoendoscopic single-port nephrectomy(LESS-N). Method From February 2012 to July 2016, 61 cases of LESS-N were performed in our center. There were 34 males and 27 females with a mean age of (60.3±9.4) years old (ranging 36-72 years old). There were thirty-nine cases of renal tumors and twenty two cases of nonfunctioning kidney. The patients were divided into two groups. Group A included 39 cases that underwent conventional LESS-N(22 radical nephrectomy/17 simple nephrectomy). Group B included 22 cases that underwent intra-abdominal exposure instruments assisted LESS-N (17 radical nephrectomy/5 simple nephrectomy). The perioperative and postoperative data were collected and analyzed retrospectively. Results All the procedures of these two groups were completed successfully. In Group A, four patients were added one 5 cm additional trocar and two patients were converted to open surgery. No additional trocars or conversion to open surgery were needed in Group B. For LESS radical nephrectomy, there were no significant differences of mean tumor diameter (5.7cm vs. 5.4 cm, P=0.65) between two groups. The average operative time was (95.1±43.9)min in Group B which was lower than that in Group A (127.4±61.9)min (P<0.01). The mean renal vascular processing time was declined from (25.4±10.1)min in Group A to (18.8±8.9)min in Group B (P<0.05). The mean estimated blood loss was (128.6±51.1)ml in Group A and (98.7±57.6)ml in Group B (P<0.05). No severe intraoperative and postoperative complications occurred in both group. Conclusions Intra-abdominal exposure instruments are feasible and effective for LESS-N. This system may shorten the operation time, reduce the amount of bleeding and improve surgical accuracy. Key words: Intra-abdominal exposure instruments; Laparoendoscopic single-site surgery; Nephrectomy