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Keywords:

  • laparoendoscopic single-site surgery;
  • LESS;
  • partial nephrectomy;
  • warm ischaemia time;
  • complications

Objective

  • To report on a large multi-institutional series of laparoendoscopic single-site (LESS) partial nephrectomy (PN) and analyse renal function and short-term oncological outcomes.

Material and Methods

  • We conducted a retrospective analysis of consecutive cases of LESS-PN performed between November 2007 and March 2012 at 11 participating institutions.
  • Demographic data and data on the main peri-operative outcomes and complications were gathered and analysed.
  • Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR).
  • Chronic kidney disease was defined in stages for each patient according to the National Kidney Foundation, Kidney Disease Outcomes Quality Initiative.

Results

  • A total of 190 cases were included in this analysis. The mean renal tumour size was 2.6 cm, and the mean PADUA score was 7.2.
  • The median operating time was 170 min with a median estimated blood loss of 150 mL. A clampless technique was used in 70 cases (36.8%) and the median warm ischaemia time (WIT) was 16.5 min.
  • PADUA score independently predicted the length of WIT (low vs high score: odds ratio 5.11, CI 1.50–17.41, P = 0.009; intermediate vs high score: odds ratio 5.13, CI 1.56–16.88, P = 0.007).
  • The overall postoperative complication rate was 14.7%. Where a clamping technique was used, a significant increase in serum creatinine concentration and a significant decrease in eGFR were observed postoperatively and at 6 months. On multivariate analysis PADUA score was the only predicting factor.
  • Overall survival rates were 99, 97 and 88% at 12-, 24- and 36-month follow-up, respectively, while disease-free survival rates were 98% at 12-month and 97% at 24- and 36-month follow-up.

Conclusion

  • The study showed that LESS-PN is effective in terms of renal function preservation and oncological control at short- and intermediate-term follow-up.