Laparoendoscopic single-site (LESS) partial nephrectomy short-term outcomes
Menée sur 14 patients atteints d'un carcinome à cellules rénales ou présentant un adénome métanéphrique ou un angiomyolipome (8 hommes et 6 femmes ; âge moyen : 57,9 ans), cette étude évalue, du point de vue de la durée du séjour hospitalier, des événements indésirables et de la récidive, les résultats à court terme d'une néphrectomie partielle par laparo-endoscopie avec accès unique
Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Laparoendoscopic single-site (LESS) surgery has been used by urologists for a broad range of operations including LESS partial nephrectomy (LESS-PN). To date, experiences of LESS-PN have been presented as small series or as a subset of larger heterogeneous operative experiences, which have shown the overall feasibility and safety of this novel technique.We report our experience with LESS-PN with complete pathological resection and excellent short-term oncological and renal functional outcomes in the select patient population who underwent this minimally invasive approach. OBJECTIVE * •To present our experience of transumbilical laparoendoscopic single-site (LESS) partial nephrectomy (PN) with pathological and short-term oncological and renal functional outcomes. PATIENTS AND METHODS * •In all, 15 LESS-PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon. * •All patients underwent transumbilical LESS using a 5-mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments. * •The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN. * •Demographic, perioperative, and postoperative variables were recorded and analysed. RESULTS * •Of the 14 patients (eight men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2–4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins. * •The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0–37) min; bull-dog clamps were used for hilar-control in nine cases with the remaining six cases done without hilar vascular clamping. * •The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions. * •The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg. * •Follow-up surveillance imaging showed no recurrence at a mean (sd, range) follow-up of 18.3 (12.2; 6–36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow-up of 17.1 (11.9; 1–36) months. CONCLUSION * •LESS-PN is a feasible and effective operation, providing complete oncological resection along with excellent short-term oncological and renal functional outcomes.
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11374.x/abstract