Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: A 5-year, single-surgeon experience

Jodi Antonelli, Aditya Bagrodia, Christopher Odom, Ephrem O. Olweny, Steven Faddegon, Jeffrey A Cadeddu

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

Background Conventional laparoscopic nephrectomy (LN) is the gold standard approach for nephrectomy. An advance in minimally invasive nephrectomy is laparoendoscopic single-site nephrectomy (LESS-N). Objective To compare 5-yr experience and outcomes of LESS-N to LN. Design, setting, and participants Retrospective, case-control, single-surgeon series of 47 LESS-N cases matched in a 1:2 fashion by age, indication, and tumor size to 94 LN controls. LESS-N procedures were performed between August 2007 and February 2012 and LN procedures between December 1999 and 2009. Intervention LESS-N or LN. Outcome measurements and statistical analysis Categorical variables were compared by χ2 analysis, and continuous variables were compared using the Mann-Whitney test. Results and limitations There were significantly more female patients (66% vs 46%; p = 0.023) and a significantly lower median body mass index (24 kg/m2 vs 28 kg/m2; p < 0.001) in the LESS-N group compared with the LN group. Surgical indication was benign in 69 patients (23 LESS-N and 46 LN) and malignant in 72 patients (24 LESS-N and 48 LN). There were no significant differences for the LESS-N and LN groups, respectively, in mean operative time (149 min vs 150 min; p = 0.9), change in hematocrit (5.6% vs 4.8%; p = 0.661), change in creatinine (0.18 mg/dl vs 0.49 mg/dl; p = 0.18), analgesic use (morphine equivalents) (18.4 vs 17.5; p = 0.81), or intraoperative complication rates (6.4% vs 2.1%; p = 0.20). Length of stay was shorter (49 h vs 70 h; p = 0.017) and estimated blood loss was lower (56 ml vs 137 ml; p = 0.002) for the LESS-N group. Over a mean follow-up of 3 yr, postoperative complications (12.8% vs 7.4%; p = 0.30), disease-free survival (95.8% vs 87.5%; p = 0.384), and overall survival (91.7% vs 95.8%; p = 0.123) were not significantly different. The most significant limitation of this study is the retrospective design. Conclusions This series demonstrates that LESS-N is safe and durable in properly selected patients; however, multi-institutional randomized trials are required to confirm benefits.

Original languageEnglish (US)
Pages (from-to)412-418
Number of pages7
JournalEuropean urology
Volume64
Issue number3
DOIs
StatePublished - Sep 1 2013

Keywords

  • Laparoendoscopic
  • Laparoscopic nephrectomy
  • Single port/incision

ASJC Scopus subject areas

  • Urology

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