Glickman Urological and Kidney Institute, Cleveland, OH, USA.
BJU Int. 2011 Apr;107(8):1284-9. doi: 10.1111/j.1464-410X.2010.09663.x. Epub 2010 Sep 14.
Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Several studies have shown the feasibility of performing both complex and reconstructive laparoendoscopic single site (LESS) surgical procedures in urology. To date, no studies have evaluated the rates of conversion to conventional laparoscopy and complications at the time of LESS procedures in urology. This study, a compilation of results from members of the NOTES working group, is the first study to address the rates of complications and conversions to conventional laparoscopy at the time of LESS surgery in urology.
• To present complications and rates of conversion from LESS to conventional laparoscopy (CL) at the time of upper tract LESS urologic procedures.
• Patients undergoing LESS upper tract procedures between September, 2007 and November, 2008 (n = 125) were identified at six high-volume academic centers pioneering urologic LESS procedures. All LESS procedures were performed transperitoneally via a single umbilical incision using either adjacent conventional trocars or a dedicated single-site access device. Reconstructive procedures incorporating a single planned 2 mm accessory needle port were included as LESS procedures and were not considered conversions. • Patients, undergoing LESS procedures requiring conversion to CL with the placement of additional ports were identified. Conversion was defined as the placement of additional 5 or 10/12 mm ports beyond the primary incision. In each case the operative reports were reviewed, the reason for conversion was determined, and the number and types of additional ports and complications were noted.
• Upper tract LESS procedures were performed in 125 patients comprising 13.3% of the total 937 laparoscopic procedures performed at the participating institutions during this time period. Conversion to CL was necessary in 7 patients (5.6%) undergoing LESS requiring the addition of 2-5 ports. • Reasons for conversion included: facilitate dissection in 3 (43%), facilitate reconstruction in 3 (43%), and control of bleeding in 1 (14%). All attempted LESS cases were completed laparoscopically without need for open conversion. • Complications occurred in 15.2% of patients undergoing LESS surgery. Three of the 7 patients that required conversion to CL developed postoperative complications (Clavien grade II in two and IIIa in one). • Limitations of this study included the inability to standardize LESS patient selection criteria, instrumentation and surgical technique as well as the lack of available complete data from a CL control group for comparison.
• LESS surgery is technically feasible for a variety of upper urinary tract reconstructive and ablative procedures, although it appears to be associated with higher rates of complications than in mature CL series. Conversion to CL occurs infrequently and may be a reflection of stringent patient selection.
• 介绍上尿路LESS 泌尿外科手术时从LESS 转为传统腹腔镜（CL）的并发症和转化率。
• 在 6 家高容量学术中心，对 2007 年 9 月至 2008 年 11 月期间接受 LESS 上尿路手术的患者进行了识别，这些中心是泌尿外科 LESS 手术的先驱。所有 LESS 手术均通过单个脐部切口经腹膜内进行，使用相邻的常规 trocar 或专用的单部位接入装置。包括纳入 LESS 手术的重建手术，这些手术结合了单个计划的 2 毫米辅助针孔端口，并且不被视为转换。• 识别出需要转为 CL 并放置额外端口的 LESS 手术患者。转换定义为在主切口之外放置额外的 5 或 10/12 毫米端口。在每种情况下，均对手术报告进行了审查，确定了转换的原因，并记录了附加端口的数量和类型以及并发症。
• 在接受 LESS 手术的 125 例患者中，上尿路 LESS 手术占同期参与机构进行的 937 例腹腔镜手术的 13.3%。在需要添加 2-5 个端口的 7 例 LESS 患者中，需要转为 CL。• 转换的原因包括：便于解剖 3 例（43%），便于重建 3 例（43%），控制出血 1 例（14%）。所有尝试的 LESS 病例均在没有需要开放转换的情况下完成腹腔镜手术。• LESS 手术患者中发生了 15.2%的并发症。在需要转为 CL 的 7 例患者中，有 3 例发生了术后并发症（2 例为 Clavien II 级，1 例为 IIIa 级）。• 本研究的局限性包括无法标准化 LESS 患者选择标准、仪器和手术技术，以及缺乏 CL 对照组的完整数据进行比较。
• LESS 手术对于各种上尿路重建和消融手术具有技术可行性，尽管它似乎与成熟的 CL 系列相比，并发症发生率更高。转为 CL 并不常见，这可能反映了严格的患者选择。
