Laparoendoscopic single‐site pyeloplasty: a comparison with the standard laparoscopic technique

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Laparoendoscopic single site surgery (LESS) is a novel technique for performing a variety of procedures including Urological upper tract reconstructive surgery. As of now few studies have compared perioperative factors and outcomes between LESS and standard laparoscopic or robotic approaches. In this comparison between LESS and standard laparoscopic pyeloplasty we identified no significant differences in terms of narcotic requirements, quality of life indicators, and outcomes although prospective evaluation is needed. OBJECTIVE • To compare laparoendoscopic single‐site (LESS) and standard laparoscopic pyeloplasty procedures with the aim of defining whether perioperative, recovery or health‐related quality of life (HRQL) benefits exist for the LESS procedure. PATIENTS AND METHODS • From November 2007 to August 2008, sixteen patients underwent LESS pyeloplasty at a tertiary care referral centre. These patients were compared with a matched cohort of patients undergoing standard laparoscopic pyeloplasty. • Matching criteria included gender and age (within 10 years), as well as preoperative degree of obstruction (T½ within 15 min) and differential renal function (within 10% ipsilaterally) based on diuretic radionuclide scanning. Mean follow‐up was 13 ± 4 months for the LESS group and 17 ± 3 months for the standard laparoscopic group. • LESS pyeloplasty procedures were all performed using a single‐port device in the umbilicus and suturing was assisted with a 2‐mm grasping instrument. Perioperative variables, successful relief of obstruction and HRQL measurements were compared between the two groups. RESULTS • Except for a lower body mass index in the LESS group (23 ± 6 kg/m2 vs 30 ± 7 kg/m2, P= 0.002), no difference was noted for perioperative variables between the two cohorts, including hospital stay and analgesic requirement. • No significant HRQL advantage was noted for either group based on a six‐item non‐validated questionnaire. • All patients in both groups experienced clinical resolution of their symptoms. A patient in the standard laparoscopy group and two patients in the LESS group had T½ > 20 min (0.063% vs 0.125%, P= 1.00) on diuretic radionuclide scanning. • Limitations include the retrospective nature of the present study, as well as the relatively small study population and short follow‐up. CONCLUSIONS • No benefit was noted for LESS pyeloplasty over the standard laparoscopic procedure beyond aesthetic advantages. • Further comparisons are needed to determine whether these results are generalizable to other LESS procedures.

‘Scarless' Laparoscopic Urologic Surgery by the Combination of Mini-Laparoscopic and Laparoendoscopic Single-Site Surgery Equipment

“…The success of the procedure in the management of ureteropelvic junction obstruction and complication rate was 83.3% (15/18 patients) and 8.8% (16/18 patients), respectively. These figures are comparable to those in the literature [12,14,17,18,19,20]. All LESS-P procedures were performed by the use of a 3 mm instrument inserted through the abdominal wall and a 5 mm instrument inserted through the umbilical multi-lumen trocar.…”

“…LESS-P has been reported in a limited number of studies [4,16,17,18,19,20,21,22]. Tracy et al [19] compared LESS-P (n = 14) to laparoscopic pyeloplasty (n = 28) and observed significantly lower mean operative time (207 vs. 237.5 min, p < 0.001) and mean blood loss (30 vs. 72.5 ml, p = 0.002) in the case of LESS-P.…”

“…An additional 5 mm instrument was inserted to facilitate suturing in all cases while an additional 3 mm instrument was placed below the xiphoid to provide tissue retraction in some cases. Stein et al [20] also compared the above procedures but did not observe any significant advantage of LESS-P over laparoscopic pyeloplasty. In fact, laparoscopic pyeloplasty was performed for the management of patients with significantly higher body mass index with similar operative time.…”

Nierenbeckenplastik – pro robotisch

“…zu immer geringeren invasiven Methoden und ggf. zu besseren kosmetischen Ergebnissen hat dazu geführt, dass inzwischen mehrere Gruppen ihre vorläufigen Ergebnisse der LESSTechnik mit ungefähr 100 Pyeloplastiken publiziert haben [8,18,22,23,25]. Auch hier bestand die Hauptschwierigkeit in der Durchführung der ureteropelvinen Anastomose, bedingt durch die bekannten Schwächen der Laparoskopie und der speziellen geometrischen Nähe der Trokare zu einander mit nahezu aufgehobener Triangulation der Instrumente.…”

Transumbilical laparoendoscopic single-site pyeloplasty in infants and children: initial experience and short-term outcome

“…In addition, it is also performed in some highly difficult reconstructive surgery and obtains good outcomes [2,5]. However, limited by equipments and surgical skills, its operative time is longer compared to that of the standard laparoscopy [6,7]. Here we report our experiences on LESS-P in 24 pediatric patients with ureteropelvic junction obstruction (UPJO).…”