Urological Laparoendoscopic Single Site Surgery: Multi-Institutional Analysis of Risk Factors for Conversion and Postoperative Complications
ABSTRACT We analyzed the incidence of and risk factors for complications and conversions in a large contemporary series of patients treated with urological laparoendoscopic single site surgery.
The study cohort consisted of consecutive patients treated with laparoendoscopic single site surgery between August 2007 and December 2010 at a total of 21 institutions. A logistic regression model was used to analyze the risks of conversion, and of any grade and only high grade postoperative complications.
Included in analysis were 1,163 cases. Intraoperatively complications occurred in 3.3% of cases. The overall conversion rate was 19.6% with 14.6%, 4% and 1.1% of procedures converted to reduced port laparoscopy, conventional laparoscopic/robotic surgery and open surgery, respectively. On multivariable analysis the factors significantly associated with the risk of conversion were oncological surgical indication (p=0.02), pelvic surgery (p<0.001), robotic approach (p<0.001), high difficulty score (p=0.004), extended operative time (p=0.03) and an intraoperative complication (p=0.001). A total of 120 postoperative complications occurred in 109 patients (9.4%) with major complications in only 2.4% of the entire cohort. Reconstructive procedure (p=0.03), high difficulty score (p=0.002) and extended operative time (p=0.02) predicted high grade complications.
Urological laparoendoscopic single site surgery can be done with a low complication rate, resembling that in laparoscopic series. The conversion rate suggests that early adopters of the technique have adhered to the principles of careful patient selection and safety. Besides facilitating future comparisons across institutions, this analysis can be useful to counsel patients on the current risks of urological laparoendoscopic single site surgery.
- SourceAvailable from: Aly M Abdel-Karim
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- "None of our patients developed an incisional hernia at the port site. In our multi-institutional analysis of risk factors of conversion and postoperative complication in 1163 patients who had LESS for different indications, postoperative complication rate was low and this was comparable with that of conventional laparoscopy . Different studies have shown that LESS results in decreased length of hospital stay, decreased analgesic use and increased patient satisfaction [3e8]. "
ABSTRACT: Although there are increasing reports in the literature about laparoendoscopic single-site surgery (LESS) as a tool for treatment of different pathologies in adults, the applications of LESS in pediatric urology are still limited. In this report we present the largest case series of LESS as an option for treatment of different urologic pathologies in pediatrics. From January 2011 to June 2013, LESS was done for variable urologic pathologies in pediatrics. Indications of LESS included undescended testes, varicocele, nehrectomy for both non-functioning and multicystic dysplastic kidneys as well as pyeloplasty. Both R-port and Covedien port were used, and were inserted through a periumbilical skin incision. Whenever R-port was used, we used both pre-bent and straight instruments, whereas with Covedien port both articulating and straight instruments were used. Pyeloplasty was done through hands-free intracorporeal suturing using 4/0 vicryl. All procedures were done by a single experienced laparoscopist. Data were collected during and after surgery then analyzed retrospectively. Twenty-two children with mean age of 6.3 ± 4.2 years had 39 LESS procedures. Thirteen patients had undescended testes (bilateral = 7, unilateral = 6, total = 20 undescended testes); 10 of them had primary orchiopexy, while nine had first stage Fowler-Stephens orchiopexy and these children subsequently had second stage Fowler-Stephens orchiopexy after 6 months and one child had orchiectomy. Four patients with varicocele (left = 3, bilateral = 1) had varicocelectomy. Two children had nephrectomy for both non-functioning hydronephrotic as well as multicystic dysplastic kidneys. Three children with ureteropelvic junction obstruction had LESS pyeloplasty, of whom two had dismembered pyeloplasty and one had non-dismembered Y-V plasty. There was no conversion to conventional laparoscopy, open surgery or adding an extra-port in any patient. Mean operative time was 89.6 ± 22.8 min. Mean blood loss was 32.2 ± 22.1 cc. No intraoperative or postoperative complications were reported. Mean hospital stay was 0.5 ± 0.6 days. Mean visual analog pain scale at discharge was 0.5 ± 0.3. Mean follow-up was 18.6 ± 6.4 months. LESS is a feasible and safe option for treatment of different urologic pathologies in pediatrics. However, more patients, indications and prospective comparative studies are needed for further evaluation of the role of LESS in pediatric urology. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.Journal of Pediatric Urology 10/2014; 11(1). DOI:10.1016/j.jpurol.2014.08.012 · 1.41 Impact Factor
- European Urology 06/2012; 62(4):613-5; discussion 615-6. DOI:10.1016/j.eururo.2012.06.028 · 12.48 Impact Factor
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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 (LESS) surgery has been used by urologists for a broad range of operations including LESS partial nephrectomy (LESS-PN). To date, experiences of LESS-PN have been presented as small series or as a subset of larger heterogeneous operative experiences, which have shown the overall feasibility and safety of this novel technique. We report our experience with LESS-PN with complete pathological resection and excellent short-term oncological and renal functional outcomes in the select patient population who underwent this minimally invasive approach. OBJECTIVE: • To present our experience of transumbilical laparoendoscopic single-site (LESS) partial nephrectomy (PN) with pathological and short-term oncological and renal functional outcomes. PATIENTS AND METHODS: • In all, 15 LESS-PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon. • All patients underwent transumbilical LESS using a 5-mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments. • The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN. • Demographic, perioperative, and postoperative variables were recorded and analysed. RESULTS: • Of the 14 patients (eight men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2-4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins. • The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0-37) min; bull-dog clamps were used for hilar-control in nine cases with the remaining six cases done without hilar vascular clamping. • The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions. • The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg. • Follow-up surveillance imaging showed no recurrence at a mean (sd, range) follow-up of 18.3 (12.2; 6-36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow-up of 17.1 (11.9; 1-36) months. CONCLUSION: • LESS-PN is a feasible and effective operation, providing complete oncological resection along with excellent short-term oncological and renal functional outcomes.BJU International 07/2012; 111(2). DOI:10.1111/j.1464-410X.2012.11374.x · 3.13 Impact Factor