Perioperative Outcomes in Patients Undergoing Conventional Laparoscopic Versus Laparoendoscopic Single-site Pyeloplasty

Objectives: To compare the outcomes of laparoendoscopic single-site (LESS) surgery with conventional laparoscopic pyeloplasty (CLP) before LESS can be widely accepted. LESS surgery is a novel technique for performing laparoscopic pyeloplasty through a single incision. Methods: Fourteen patients undergoing less pyeloplasty were matched 2:1 with regard to age and side of surgery to a previous cohort of 28 patients who underwent CLP. All patients underwent surgery for symptomatic ureteropelvic junction obstruction and/or delayed urinary excretion based on functional imaging. Intracorporeal suturing was aided through a 5-mm instrument placed in the eventual drain site. Results: No difference was observed between the LESS and CLP cohorts in regard to preoperative characteristics. Postoperatively, no difference was noted between LESS and CLP cases in regard to length of stay (77 vs 74 hours; P = .69), morphine equivalents required (34 vs 38; P = .93), minor postoperative complications (14.3% vs 14.3%; P = 1.0), or major postoperative complications (21.4% vs 10%; P = .18). Median operative times (207 vs 237.5 minutes; P <.001) and median estimated blood loss (30 vs 72.5 mL; P = .002) were lower in patients undergoing LESS. Detailed follow-up imaging revealed a success rate of 96% for CLP at 14.6 months (86% follow-up) and 100% for LESS at 6.8 months (71% follow-up). Conclusions: Although LESS pyeloplasty is feasible, all measured perioperative outcomes are similar to CLP. Further studies are needed to better define the appropriate role of LESS surgery in urology.