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Laparoendoscopic single-site nephrectomy with the aid of intraabdominal retractors

  • Jian Su
  • Qingyi Zhu
  • Lin Yuan
  • Yang Zhang
  • Zhonglei Deng
  • Qingling Zhang
  • Yunfei Wei
  • Luming Shen
Urology - Original paper

Abstract

Objectives

To evaluate the feasibility and clinical efficacy of a novel intraabdominal retractor device in laparoendoscopic single-site nephrectomy(LESS-N).

Methods

Between February 2012 and February 2017, 98 patients underwent LESS-N in our institution, including 38 patients with benign renal disease and 60 patients with malignant renal disease. 39 were performed conventional LESS-N(C-LESS-N) and 59 were performed intraabdominal retractor-assisted LESS-N(IAR-LESS-N). Demographic data, and perioperative and postoperative data were collected and analyzed retrospectively.

Results

All the procedures were completed successfully. In C-LESS-N group, four patients were added one 5-mm additional trocar and two patients were converted to open surgery. In IAR-LESS-N group, no patients required additional trocars or conversion to open surgery. The mean operative time was lower in IAR-LESS-N group than that in C-LESS-N group (94.2 min vs 127.4 min, P < 0.05). The mean renal vascular management time declined from 25.4 min in C-LESS-N group to 18.4 min in IAR-LESS-N group (P < 0.05). The mean estimated blood loss was 128.6 ml in C-LESS-N group and 102.3 ml in IAR-LESS-N group (P < 0.05). Two patients in C-LESS-N group required blood transfusion, while none of the patients in IAR-LESS-N group did. No severe postoperative complications occurred in both groups. Study limitations included retrospective study, short follow-up, and accumulated surgical experience and skills.

Conclusions

Intraabdominal retractors allow performance of LESS-N with improved working space, quicker renal hilar management, and shortened total operative time. It is expected that the application of intraabdominal retractors, along with the new robotic platform might revive LESS and translate into a renewed future interest of LESS.

Keywords

Laparoendoscopic single-site surgery Nephrectomy Intraabdominal retractor 

Notes

Funding

This study was funded by Jiangsu Provincial Hospital of Traditional Chinese Medicine (Grant Number: Y-17065).

Compliance with ethical standards

Conflict of interest

Author Deng Zhonglei has received the research grant from Jiangsu Provincial Hospital of Traditional Chinese Medicine. Authors Su Jian, Zhu Qingyi, Yuan Lin, Zhang Yang, Zhang Qingling, Wei Yunfei, and Shen Luming declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethics committee of Jiangsu Provincial Hospital of Traditional Chinese Medicine and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Autorino R, Brandao LF, Sankari B,et al (2015) Laparoendoscopic single-site (LESS) vs laparoscopic living-donor nephrectomy: a systematic review and meta-analysis. BJU Int 115:206–215CrossRefGoogle Scholar
  2. 2.
    Park JY, Kim DY, Suh DS et al (2014) Laparoendoscopic single-site versus conventional laparoscopic surgical staging for early-stage endometrial cancer. Int J Gynecol Cancer 24:358–363CrossRefGoogle Scholar
  3. 3.
    Gurluler E, Berber I, Cakir U, Gurkan A (2014) Laparoendoscopic single-site donor nephrectomy:a single-center initial experience. Ann Transpl 30:551–555Google Scholar
  4. 4.
    Hora M, Ürge T, Stránský P et al (2014) Laparoendoscopic single-site surgery adrenalectomy - own experience and matched case-control study with standard laparoscopic adrenalectomy. Wideochir Inne Tech Malo Inwazyjne 9:596–602Google Scholar
  5. 5.
    Park SY, Rha KH, Autorino R et al (2013) Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: outcomes of an international multi-institutional study of 101 patients. BJU Int 112:610–615CrossRefGoogle Scholar
  6. 6.
    Liatsikos E, Kyriazis I, Kallidonis P et al (2012) Pure single-port laparoscopic surgery or mix of techniques? World J Urol 30:581–587CrossRefGoogle Scholar
  7. 7.
    Brown-Clerk B, de Laveaga AE, LaGrange CA et al (2011) Laparoendoscopic single-site(LESS) surgery versus conventional laparoscopic surgery: comparison of surgical port performance in a surgical simulator with novices. Surg Endosc 25:2210–2218CrossRefGoogle Scholar
  8. 8.
    Rane A, Kommu S, Eddy B, Bonadio F, Rao P (2007) Clinical evaluation of a novel laparoscopic port(R-Port TM) in urology and evolution of the single laparoscopic port procedure(SLIPP). J Endourol 21(Supp 11):A22–A23Google Scholar
  9. 9.
    Tugcu V, Ilbey YO, Mutlu B et al (2010) Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol 24:1315–1320CrossRefGoogle Scholar
  10. 10.
    Raman JD, Bagrodia A, Cadeddu JA (2009) Single-incision umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 55:1198–1204CrossRefGoogle Scholar
  11. 11.
    Sorokin I, Canvasser NE, Irwin B,et al (2017) The decline of laparoendoscopic single-site surgery: a survey of the endourological society to identify shortcomings and guidance for future directions. J Endourol 31:1049–1055CrossRefGoogle Scholar
  12. 12.
    Desai MM, Strzempkowski B, Matin SF et al (2005) Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy. J Urol 173:38–41CrossRefGoogle Scholar
  13. 13.
    Fan X, Xu K, Lin T et al (2012) Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. BJU Int 111:611–621CrossRefGoogle Scholar
  14. 14.
    Taue R, Izaki H, Koizumi T et al (2009) Transperitoneal versus retroperitoneal laparoscopic radical nephrectomy: a comparative study. Int J Urol 16:263–267CrossRefGoogle Scholar
  15. 15.
    Han WK, Tan YK, Olweny EO et al (2013) Comparison between magnetic anchoring and guidance system camera-assisted laparoendoscopic single-site surgery nephrectomy and conventional laparoendoscopic single-site surgery nephrectomy in a porcine model: focus on ergonomics and workload profiles. J Endourol 27:490–496CrossRefGoogle Scholar
  16. 16.
    Hora M, Eret V, Stransky P et al (2014) Position of laparoendoscopic single-site surgery nephrectomy in clinical practice and comparison (matched case-control study) with standard laparoscopic nephrectomy. Videosurg Miniinv 9:371–379CrossRefGoogle Scholar
  17. 17.
    Zhang SD, Ma LL, Huang Y et al (2013) Technical improvement of transumbilical laparoendscopic single-site nephrectomy. Beijing Da Xue Xue Bao 45:579–583Google Scholar
  18. 18.
    Greco F, Veneziano D, Wagner S et al (2012) Laparoendoscopic single-site radical nephrectomy for renal cancer: technique and surgical outcomes. Eur Urol 62:168–174CrossRefGoogle Scholar
  19. 19.
    Cheng J, Chen J, Sheng X,et al (2015) Oncologic and functional outcomes of laparoendoscopic single-site radical nephrectomy for localized kidney cancer: a single surgeon’s series with a minimum of 3-year follow-up. J Endourol 29:1242–1247CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of UrologyAffiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese MedicineNanjingChina

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