Laparoendoscopic single‐site (LESS) robot‐assisted partial nephrectomy (RAPN) reduces postoperative wound pain without a rise in complication rates

Abstract

ObjectiveTo compare long-term functional outcomes and pain scale scores of patients who underwent laparoendoscopic single-site (LESS)-robot-assisted partial nephrectomy (RAPN) to those who underwent conventional RAPN (C-RAPN), as LESS surgery is increasingly being adopted by urologists worldwide to reduce morbidities and scarring associated with surgical interventions. Patients and MethodsIn all, 167 consecutive patients who had RAPN were identified from our Institutional Review Board-approved computerised database between October 2006 to July 2012. Patients were stratified into two groups: 80 patients who underwent C-RAPN and 79 who underwent LESS-RAPN. ResultsThe LESS-RAPN group had a longer warm ischaemia time [WIT, mean (SD) ConclusionsDespite a significantly longer WIT and TOT, the functional outcomes of LESS-RAPN were comparable to those of C-RAPN for tumours of similar mean sizes and complexities, without any detriments in oncological and complications outcomes. On discharge, patients who underwent LESS-RAPN also reported lower pain levels as one of the advantages of minimally invasive surgery. With the development of instrumentation specifically designed for single-site surgery, LESS could be more easily conducted in patients who are interested in improved quality of life outcomes.

Laparoendoscopic single-site nephrectomy versus conventional laparoendoscopic nephrectomy for kidney tumor: a systematic review and meta-analysis

“…Ten studies reported about radical nephrectomy (RN) [12–17,21,22–24]. Two studies were about partial nephrectomy (PN) [19,20]. Both RN and PN were reported by Kim et al [18], so we used Kim (RN) and Kim (PN) as RN and PN in the present study, respectively.…”

“…Both RN and PN were reported by Kim et al [18], so we used Kim (RN) and Kim (PN) as RN and PN in the present study, respectively. Two studies reported robot-assisted nephrectomy [14,19].…”

“…There was no statistical difference in the conversion rate between the two groups (OR = 1.69, 95% CI = 0.62–4.61; P =0.309) [12–14,16,19–22,24] (Figure 3A). Eight studies [12–13,15–18,21–22] reported perioperative complications in 351 patients, and the pooled data showed no difference between the LESS-N group and the CL-N group (OR = 1.74, 95% CI = 0.93–3.25; P =0.082) (Figure 3B).…”

“…Eight studies [12–13,15–18,21–22] reported perioperative complications in 351 patients, and the pooled data showed no difference between the LESS-N group and the CL-N group (OR = 1.74, 95% CI = 0.93–3.25; P =0.082) (Figure 3B). The pooled data of intraoperative complications [12,19–21,24] and postoperative complications [12,13,19–21,24], both showed no statistically difference between the two groups (OR = 1.54, 95%CI = 0.59–4.04, P =0.383; OR = 1.35, 95% CI = 0.82–2.24, P =0.240, respectively) (Figure 3C,D). Five studies [12,14,19–20,24] divided postoperative complications into minor and major complications and the pooled data both showed no difference in minor complications and major complications between two groups (OR = 1.25, 95% CI = 0.72–2.16, P =0.426; OR = 2.13, 95% CI = 0.59–7.74, P =0.250) (Figure 3E,F).…”

Is it possible to achieve anything MORE going down the LESS route?

“…In the preceding paper, Shin et al. report outcomes comparing conventional robot‐assisted partial nephrectomy (C‐RAPN) with laparoendoscopic single‐site (LESS)‐RAPN. This study is a follow‐up of their recently published paper on the same cohort of patients on trifecta of PN .…”