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.
Highlights
Over the last decades, open nephrectomy for kidney tumor has been gradually replaced by laparoendoscopic nephrectomy first reported by Clayman et al in 1991 [1] and it has been demonstrated to gain great advantages in cosmetic appearance, postoperative pain, hospital stay and perioperative complications [2,3]
As for laparoendoscopic single-site (LESS) nephrectomy (LESS-N), it is a kind of minimally invasive surgery based on LESS, which is performed through a single incision, usually around the umbilical or transperitoneal region
Ten studies reported about radical nephrectomy (RN) [12–17,21,22–24]
Summary
Open nephrectomy for kidney tumor has been gradually replaced by laparoendoscopic nephrectomy first reported by Clayman et al in 1991 [1] and it has been demonstrated to gain great advantages in cosmetic appearance, postoperative pain, hospital stay and perioperative complications [2,3]. New less invasive technologies have been applied in treatment including Natural orifice transluminal endoscopic surgery (NOTES) [4] and laparoendoscopic single-site (LESS) surgery [5]. LESS has gained a lot of attention since it was first reported in Urology in 2007 [5]. As for LESS nephrectomy (LESS-N), it is a kind of minimally invasive surgery based on LESS, which is performed through a single incision, usually around the umbilical or transperitoneal region. An additional 3-mm trocar used in right kidney nephrectomies for liver retraction is considered as LESS-N [5,6].
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