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.
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ABSTRACT: Robotic laparoendoscopic single-site partial nephrectomy is increasingly carried out in an attempt to improve the cosmetic outcome of minimally-invasive procedures. However, the actual role of this novel technique remains to be determined. The present article reviews evidence and examines updates of robotic laparoendoscopic single-site partial nephrectomy outcomes reported in more contemporary studies. A comprehensive online systematic search of PubMed, Scopus and Web of Science databases according to Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria recommendations was carried out in January 2014, identifying data from 2008 to 2014 regarding robotic laparoendoscopic single-site partial nephrectomy. The majority of medical evidence to date is based on case reports or retrospective studies. Current studies show that robotic laparoendoscopic single-site partial nephrectomy is a feasible procedure carried out in an acceptable length of operative time, and resulting in a desirable cosmetic outcome and less postoperative pain. However, comparable studies show that robotic laparoendoscopic single-site partial nephrectomy is inferior to the conventional approach, especially with regard to warm ischemia time. Furthermore, the numerous limitations that exist with the utilization of the current commercial single-site devices make robotic laparoendoscopic single-site PN more challenging and more complicated for surgeons compared with conventional procedures. Further significant improvements, along with more studies, are required in order to develop the ideal robotic laparoendoscopic single-site robotic platform and overcome the current limitations. For the time being, robotic laparoendoscopic single-site partial nephrectomy procedures could be applicable in patients with low tumor size and complexity, and should not be routinely applied in all cases.International Journal of Urology 08/2014; 21(10). DOI:10.1111/iju.12558 · 1.80 Impact Factor
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ABSTRACT: The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery.European Urology 07/2014; 66(6). DOI:10.1016/j.eururo.2014.06.039 · 12.48 Impact Factor
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ABSTRACT: Objective To compare long-term functional outcomes and pain scale scores of patients who underwent laparoendoscopic single-site (LESS)-robot-assisted partial nephrectomy (RAPN) to those who underwent conventional RAPN (C-RAPN), as LESS surgery is increasingly being adopted by urologists worldwide to reduce morbidities and scarring associated with surgical interventions. Patients and Methods In all, 167 consecutive patients who had RAPN were identified from our Institutional Review Board-approved computerised database between October 2006 to July 2012. Patients were stratified into two groups: 80 patients who underwent C-RAPN and 79 who underwent LESS-RAPN. Results The LESS-RAPN group had a longer warm ischaemia time [WIT, mean (SD) 26.5 (10.5) vs 19.8 (13.1) min; P = 0.001] and total operation time [TOT, mean (SD) 210.3 (83.4) vs 183.1 (76.1) min; P = 0.033] when compared with the C-RAPN group. While, the LESS-RAPN group and C-RAPN group were not significantly different for the number of patients with negative surgical margins [77 (96.2%) vs 73 (91.4%); P = 0.194), absolute change in postoperative renal function [mean (SD) -6.5 (16.7)% vs -7.6 (16.7)%; P = 0.738) and postoperative complications rate [12 (15.0%) vs 10 (12.6%); P = 0.279). Furthermore, the LESS-RAPN group had lower visual analogue pain scale (VAPS) scores at discharge [mean (SD) 2.1 (1.3) vs 1.7 (1.0); P = 0.048]. Conclusions Despite a significantly longer WIT and TOT, the functional outcomes of LESS-RAPN were comparable to those of C-RAPN for tumours of similar mean sizes and complexities, without any detriments in oncological and complications outcomes. On discharge, patients who underwent LESS-RAPN also reported lower pain levels as one of the advantages of minimally invasive surgery. With the development of instrumentation specifically designed for single-site surgery, LESS could be more easily conducted in patients who are interested in improved quality of life outcomes.BJU International 06/2014; 114(4). DOI:10.1111/bju.12783 · 3.13 Impact Factor