Laparoendoscopic single-site(LESS) radical nephrectomy and standard laparoscopy: a comparison of therapeutic outcomes

Abstract

Objective To compare the therapeutic outcomes of laparoendoscopic single-site(LESS)radical nephrectomy and standard laparoscopy,so as to understand the clinical advantages of transumbilical LESS radical nephrectomy.Methods Between Sep.2008 and Jan.2011,a single urologist in our center performed 105transperitoneal laparoscopic radical nephrectomies,including 21transumbilical LESS radical nephrectomies(Group A,Sep.2009and Jan.2011).This group was subsequently matched to 21standard laparoscopic RN procedures(Group B,Sep.2008 and Mar.2010).The perioperative outcomes and follow-up information,including scores of cosmetic satisfaction,were retrospectively analyzed in the two groups.The two groups were matched in patient age,body mass index,tumor size and location,and surgical indication(T1 stage).Results The LESS group had significantly quicker bowel function recovery([31.6±17.98]h vs[42.3±19.94]h,P 0.05),lower postoperative pain score(3.5±0.84vs 4.1±1.06,P0.05),and a better cosmetic satisfaction score(8.2± 0.71vs 7.3±0.85,P0.05).Notably,the mean operation periods for the first 10cases were significantly different between the two groups(P=0.030),but not significantly for the last 10cases(P=0.495)and for the whole group(P=0.076).Both groups remained metastasis-and recurrence-free during mean follow-up periods of(8.4±4.41)and(20.0±3.95)months(P=0.000).Conclusion The transumbilical LESS radical nephrectomy offers a better postoperative pain control,quicker recovery of bowel function,and a better cosmetic satisfaction compared with standard nephrectomy,but its therapeutic effect needs to be verified by long-term follow-up.The learning curve of this procedure appears not so steep for an experienced laparoscopist following a strict specialized training course.