Laparoendoscopic single-site nephrectomy with the aid of intraabdominal retractors
To evaluate the feasibility and clinical efficacy of a novel intraabdominal retractor device in laparoendoscopic single-site nephrectomy(LESS-N).
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.
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.
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.
KeywordsLaparoendoscopic single-site surgery Nephrectomy Intraabdominal retractor
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.
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 was obtained from all individual participants included in the study.
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