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Hybrid laparoendoscopic single-site surgery of upper urinary tract with the use of mini-laparoscopic instruments: cosmetic outcome and midterm oncological outcome

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Abstract

Purpose

To evaluate the efficacy of mini-laparoscopic instruments in combination with laparoendoscopic single-site surgery (LESS) instruments for the performance of oncological urological surgery.

Methods

Thirty-five patients underwent oncological hybrid LESS either mini-laparoscopic-assisted LESS partial nephrectomy (LESS-PN, n = 12) or mini-laparoscopic-assisted LESS radical nephrectomy (LESS-RN, n = 23). Perioperative data were prospectively collected. The patient and observer scar assessment scale (POSAS) was used for the evaluation of the cosmetic outcome.

Results

Mean tumor size treated by LESS-PNs was 28.8 (IQR 20.5–37.3) mm. Average operative time and blood loss were 123 (IQR 112.5–145) min and 158.3 (IQR 100–200) ml, respectively. Renal artery clamping took place in seven cases. LESS-RN was performed in cases with a mean tumor size of 60 (IQR 48–71.5) mm. The average operative time was 116.8 (IQR 100–130) min. Average blood loss was 137 (IQR 100–150) ml. Complications were limited to grade II according to Clavien classification. The oncological outcome, including midterm results, was directly comparable to the literature. Patients reported low pain scores and high satisfaction in terms of postoperative scarring. The POSAS scores confirmed the excellent cosmetic outcome of hybrid LESS.

Conclusion

The combination of mini-laparoscopic and LESS instrumentation as routine equipment of oncological surgery provided an efficient option for urologic surgery. The combination of mini-laparoscopic and LESS instruments improves the intraoperative ergonomics of LESS-PN and LESS-RN. The provided surgical and oncological outcome compares favorably to the LESS and conventional laparoscopic literature.

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References

  1. Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, Lima E, Montorsi F, Richstone L, Stolzenburg JU, Kaouk JH (2011) Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 59(1):26–45. doi:10.1016/j.eururo.2010.08.030

    Article  PubMed  Google Scholar 

  2. Kallidonis P, Kontogiannis S, Kyriazis I, Georgiopoulos I, Al-Aown A, Stolzenburg JU, Liatsikos E (2013) Laparoendoscopic single-site surgery in kidney surgery: clinical experience and future perspectives. Curr Urol Rep 14(5):496–505. doi:10.1007/s11934-013-0346-5

    Article  PubMed  Google Scholar 

  3. Kallidonis P, Georgiopoulos I, Kyriazis I, Al-Aown A, Kontogiannis S, Stolzenburg JU, Liatsikos EN (2014) ‘Scarless’ laparoscopic urologic surgery by the combination of mini-laparoscopic and laparoendoscopic single-site surgery equipment. Urol Int 92(4):414–421. doi:10.1159/000354733

    Article  PubMed  Google Scholar 

  4. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, Artibani W (2009) Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56(5):786–793. doi:10.1016/j.eururo.2009.07.040

    Article  PubMed  Google Scholar 

  6. Draaijers LJ, Tempelman FR, Botman YA, Tuinebreijer WE, Middelkoop E, Kreis RW, van Zuijlen PP (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113(7):1960–1965 (discussion 1966–1967)

    Article  PubMed  Google Scholar 

  7. Singer AJ, Church AL, Forrestal K, Werblud M, Valentine SM, Hollander JE (1997) Comparison of patient satisfaction and practitioner satisfaction with wound appearance after traumatic wound repair. Acad Emerg Med 4(2):133–137

    Article  CAS  PubMed  Google Scholar 

  8. Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406. doi:10.1016/j.eururo.2010.06.032

    Article  PubMed  Google Scholar 

  9. Merseburger AS, Herrmann TR, Shariat SF, Kyriazis I, Nagele U, Traxer O, Liatsikos EN (2013) EAU guidelines on robotic and single-site surgery in urology. Eur Urol 64(2):277–291. doi:10.1016/j.eururo.2013.05.034

    Article  PubMed  Google Scholar 

  10. Humphrey JE, Canes D (2012) Transumbilical laparoendoscopic single-site surgery in urology. Int J Urol 19(5):416–428. doi:10.1111/j.1442-2042.2012.02963.x

    Article  PubMed  Google Scholar 

  11. Stolzenburg JU, Kallidonis P, Hellawell G, Do M, Haefner T, Dietel A, Liatsikos EN (2009) Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur Urol 56(4):644–650. doi:10.1016/j.eururo.2009.06.022

    Article  PubMed  Google Scholar 

  12. Schauer PR, Ikramuddin S, Luketich JD (1999) Minilaparoscopy. Semin Laparosc Surg 6(1):21–31

    CAS  PubMed  Google Scholar 

  13. Porpiglia F, Autorino R, Cicione A, Pagliarulo V, Falsaperla M, Volpe A, Gozen AS, Celia A, De Sio M, Saita A, Damiano R, Zacchero M, Fiori C, Terrone C, Bertolo R, Greco F, Breda A, Lima E, Rassweiler J (2014) Contemporary urologic minilaparoscopy: indications, techniques, and surgical outcomes in a multi-institutional European cohort. J Endourol 28(8):951–957. doi:10.1089/end.2014.0134

    Article  PubMed  Google Scholar 

  14. Autorino R, Kim FJ, Rassweiler J, De Sio M, Ribal MJ, Liatsikos E, Damiano R, Cindolo L, Bove P, Schips L, Rane A, Quattrone C, Correia-Pinto J, Lima E (2012) Mini-laparoscopy, laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery-assisted laparoscopy: novice surgeons’ performance and perception in a porcine nephrectomy model. BJU Int 110(11 Pt C):E991–E996. doi:10.1111/j.1464-410X.2012.11289.x

    Article  PubMed  Google Scholar 

  15. Fiori C, Morra I, Bertolo R, Mele F, Chiarissi ML, Porpiglia F (2013) Standard vs mini-laparoscopic pyeloplasty: perioperative outcomes and cosmetic results. BJU Int 111(3 Pt B):E121–E126. doi:10.1111/j.1464-410X.2012.11376.x

    Article  PubMed  Google Scholar 

  16. Simforoosh N, Abedi A, Hosseini Sharifi SH, Poor Zamany NKM, Rezaeetalab GH, Obayd K, Soltani MH (2014) Comparison of surgical outcomes and cosmetic results between standard and mini laparoscopic pyeloplasty in children younger than 1 year of age. J Pediatr Urol 10(5):819–823. doi:10.1016/j.jpurol.2014.01.026

    Article  CAS  PubMed  Google Scholar 

  17. Afaneh C, Aull MJ, Gimenez E, Wang G, Charlton M, Leeser DB, Kapur S, Del Pizzo JJ (2011) Comparison of laparoendoscopic single-site donor nephrectomy and conventional laparoscopic donor nephrectomy: donor and recipient outcomes. Urology 78(6):1332–1337. doi:10.1016/j.urology.2011.04.077

    Article  PubMed  Google Scholar 

  18. Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D, Desai MR, Rao PP, Sotelo R, Stein R, Gill IS (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74(4):805–812. doi:10.1016/j.urology.2009.02.083

    Article  PubMed  Google Scholar 

  19. White WM, Haber GP, Goel RK, Crouzet S, Stein RJ, Kaouk JH (2009) Single-port urological surgery: single-center experience with the first 100 cases. Urology 74(4):801–804. doi:10.1016/j.urology.2009.04.030

    Article  PubMed  Google Scholar 

  20. Greco F, Autorino R, Rha KH, Derweesh I, Cindolo L, Richstone L, Herrmann TR, Liatsikos E, Sun Y, Fanizza C, Nagele U, Stolzenburg JU, Rais-Bahrami S, Liss MA, Schips L, Kassab A, Wang L, Kallidonis P, Wu Z, Young ST, Mohammed N, Haber GP, Springer C, Fornara P, Kaouk JH (2013) Laparoendoscopic single-site partial nephrectomy: a multi-institutional outcome analysis. Eur Urol 64(2):314–322. doi:10.1016/j.eururo.2013.01.025

    Article  PubMed  Google Scholar 

  21. Springer C, Greco F, Autorino R, Rha KH, Derweesh I, Cindolo L, Richstone L, Herrmann TR, Liatsikos E, Sun Y, Fanizza C, Nagele U, Stolzenburg JU, Rais-Bahrami S, Liss MA, Schips L, Kassab A, Wang L, Kallidonis P, Wu Z, Young ST, Altieri VM, Haber GP, Fornara P, Kaouk JH (2014) Analysis of oncological outcomes and renal function after laparoendoscopic single-site (LESS) partial nephrectomy: a multi-institutional outcome analysis. BJU Int 113(2):266–274. doi:10.1111/bju.12376

    Article  PubMed  Google Scholar 

  22. Ficarra V, Rossanese M, Gnech M, Novara G, Mottrie A (2014) Outcomes and limitations of laparoscopic and robotic partial nephrectomy. Curr Opin Urol 24(5):441–447. doi:10.1097/mou.0000000000000095

    Article  PubMed  Google Scholar 

  23. Springer C, Hoda MR, Fajkovic H, Pini G, Mohammed N, Fornara P, Greco F (2013) Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long-term oncological and functional outcomes in 340 patients. BJU Int 111(2):281–288. doi:10.1111/j.1464-410X.2012.11280.x

    Article  PubMed  Google Scholar 

  24. Volpe A, Amparore D, Mottrie A (2013) Treatment outcomes of partial nephrectomy for T1b tumours. Curr Opin Urol 23(5):403–410. doi:10.1097/MOU.0b013e328363a5c0

    Article  PubMed  Google Scholar 

  25. Rais-Bahrami S, George AK, Montag S, Okhunov Z, Richstone L (2013) Laparoendoscopic single-site (LESS) partial nephrectomy short-term outcomes. BJU Int 111(2):264–270. doi:10.1111/j.1464-410X.2012.11374.x

    Article  PubMed  Google Scholar 

  26. Favaretto RL, Sanchez-Salas R, Benoist N, Ercolani M, Forgues A, Galiano M, Rozet F, Prapotnich D, Barret E, Cathelineau X (2013) Oncologic outcomes after laparoscopic partial nephrectomy: mid-term results. J Endourol 27(1):52–57. doi:10.1089/end.2012.0132

    Article  PubMed  Google Scholar 

  27. Fearmonti R, Bond J, Erdmann D, Levinson H (2010) A review of scar scales and scar measuring devices. Eplasty 10:e43

    PubMed  PubMed Central  Google Scholar 

  28. Fan X, Lin T, Xu K, Yin Z, Huang H, Dong W, Huang J (2012) Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol 62(4):601–612. doi:10.1016/j.eururo.2012.05.055

    Article  PubMed  Google Scholar 

  29. Park YH, Lee ES, Kim HH, Kwak C, Ku JH, Lee SE, Byun SS, Hong SK, Kim YJ, Kang SH, Hong SH (2014) Long-term oncologic outcomes of hand-assisted laparoscopic radical nephrectomy for clinically localized renal cell carcinoma: a multi-institutional comparative study. J Laparoendosc Adv Surg Tech A 24(8):556–562. doi:10.1089/lap.2014.0035

    Article  PubMed  Google Scholar 

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Authors’ contributions

Kallidonis involved in protocol development, data collection, and data analysis, wrote, and edited the manuscript. Kyriazis involved in data collection and data analysis. Kamal involved in data collection and data analysis. Porpiglia involved in protocol development, data management, and data analysis, and edited the manuscript. Liatsikos involved in protocol development, data management, and data analysis, and edited the manuscript.

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Authors and Affiliations

  1. Department of Urology, University of Patras , Patras, Greece

    Panagiotis Kallidonis, Jason Kyriazis, Wissam Kamal & Evangelos Liatsikos

  2. Department of Urology, San Luigi Gonzaga Hospital-Orbassano, University of Turin, Turin, Italy

    Francesco Porpiglia

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  1. Panagiotis Kallidonis
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  2. Jason Kyriazis
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Correspondence to Evangelos Liatsikos.

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No conflicts of interest are declared by the authors.

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All data were collected in databases approved by the participating institutions. Informed consent was obtained from all patients.

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Kallidonis, P., Kyriazis, J., Kamal, W. et al. Hybrid laparoendoscopic single-site surgery of upper urinary tract with the use of mini-laparoscopic instruments: cosmetic outcome and midterm oncological outcome. World J Urol 34, 1221–1228 (2016). https://doi.org/10.1007/s00345-016-1761-2

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  • DOI: https://doi.org/10.1007/s00345-016-1761-2

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