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: Significant advances have been achieved in the field of urologic laparo-endoscopic single-site surgery (LESS) since the first reported clinical series in 2007. The aim of the present review paper is to summarize and critically analyze the most recent advances in the field of urologic LESS. A literature review was performed using PubMed to retrieve publications related to LESS in urology over the last two years (from January 2011 to May 2012). In the free-text protocol, the following terms were applied: LESS; single port laparoscopy; single incision laparoscopy. Despite unsolved challenges, LESS can be regarded as an emerging trend in minimally invasive urologic surgery and it has significantly evolved, becoming a widely applicable technique in a relatively short time. Outcomes demonstrate that a broad range of procedures can be effectively and safely done, given a solid laparoscopic surgical background and stringent patient-selection criteria. The recent introduction of a purpose-built instrumentation is likely to further foster the application of robotics to LESS. Further improvements are needed before this technique might reach a widespread adoption. Future advances in the field of robotic technology are expected to overcome the current limitations of LESS.01/2012; 65(4):204-11. DOI:10.5173/ceju.2012.04.art5
- 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