Laparoendoscopic single-site pyeloplasty: a comparison with the standard laparoscopic technique

Authors


Robert J. Stein, Cleveland Clinic, Glickman Urological and Kidney Institute, Q10, 9500 Euclid Avenue, Cleveland, OH 44195, USA. e-mail: steinr@ccf.org

Abstract

Study Type – Therapy (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

Laparoendoscopic single site surgery (LESS) is a novel technique for performing a variety of procedures including Urological upper tract reconstructive surgery. As of now few studies have compared perioperative factors and outcomes between LESS and standard laparoscopic or robotic approaches. In this comparison between LESS and standard laparoscopic pyeloplasty we identified no significant differences in terms of narcotic requirements, quality of life indicators, and outcomes although prospective evaluation is needed.

OBJECTIVE

• To compare laparoendoscopic single-site (LESS) and standard laparoscopic pyeloplasty procedures with the aim of defining whether perioperative, recovery or health-related quality of life (HRQL) benefits exist for the LESS procedure.

PATIENTS AND METHODS

• From November 2007 to August 2008, sixteen patients underwent LESS pyeloplasty at a tertiary care referral centre. These patients were compared with a matched cohort of patients undergoing standard laparoscopic pyeloplasty.

• Matching criteria included gender and age (within 10 years), as well as preoperative degree of obstruction (T½ within 15 min) and differential renal function (within 10% ipsilaterally) based on diuretic radionuclide scanning. Mean follow-up was 13 ± 4 months for the LESS group and 17 ± 3 months for the standard laparoscopic group.

• LESS pyeloplasty procedures were all performed using a single-port device in the umbilicus and suturing was assisted with a 2-mm grasping instrument. Perioperative variables, successful relief of obstruction and HRQL measurements were compared between the two groups.

RESULTS

• Except for a lower body mass index in the LESS group (23 ± 6 kg/m2 vs 30 ± 7 kg/m2, P= 0.002), no difference was noted for perioperative variables between the two cohorts, including hospital stay and analgesic requirement.

• No significant HRQL advantage was noted for either group based on a six-item non-validated questionnaire.

• All patients in both groups experienced clinical resolution of their symptoms. A patient in the standard laparoscopy group and two patients in the LESS group had T½ > 20 min (0.063% vs 0.125%, P= 1.00) on diuretic radionuclide scanning.

• Limitations include the retrospective nature of the present study, as well as the relatively small study population and short follow-up.

CONCLUSIONS

• No benefit was noted for LESS pyeloplasty over the standard laparoscopic procedure beyond aesthetic advantages.

• Further comparisons are needed to determine whether these results are generalizable to other LESS procedures.

Ancillary