Patel Hiten D, Mullins Jeffrey K, Pierorazio Phillip M, Hyams Elias S, Allaf Mohamad E
Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Can J Urol. 2011 Jun;18(3):5745-50.
Laparoendoscopic single-site surgery (LESS) has emerged as a natural progression from standard laparoscopy toward minimization of surgical morbidity. We present our initial experience with LESS renal surgery in order to assess safety, feasibility, and early postoperative outcomes.
Patients undergoing LESS renal surgery by a single surgeon from November 2008 to June 2010 were retrospectively identified. Safety, feasibility, and early outcomes were analyzed. Pain parameters were assessed using morphine equivalents used and visual analog pain scores (VAPS).
LESS procedures included 13 radical nephrectomy (1 bilateral), 5 simple nephrectomy (1 bilateral), 2 partial nephrectomy, 2 renal biopsy, and 1 renal cryoablation. Of 17 renal tumors, 15 were renal cell carcinoma and 2 had known renal vein involvement. Mean patient age was 55.4 years and mean BMI was 25.5 kg/m2. Mean operative time was 131 minutes (38-230), median estimated blood loss was 50 mL, and median length of stay was 2 days. There was one intraoperative transfusion and one conversion to conventional laparoscopy. The postoperative complication rate was 12% with two Clavien grade > 2 complications. Mean morphine equivalent dose of intravenous narcotics was 21.7 mg, and mean VAPS scores were 4.3, 3.5, and 2.9/10 on POD#0, #1, and day of discharge, respectively.
LESS surgery is safe and feasible for a wide variety of renal surgeries. Despite the selection bias of this early experience, postoperative outcomes and pain scores appear comparable to those reported for standard laparoscopy. Prospective studies comparing LESS to standard laparoscopic renal surgery are needed for definitive assessment.
腹腔镜单切口手术（LESS）已成为从标准腹腔镜手术自然发展而来的一种术式，旨在将手术并发症降至最低。我们介绍我们在LESS肾手术方面的初步经验，以评估其安全性、可行性和术后早期结果。
回顾性确定2008年11月至2010年6月由同一外科医生进行LESS肾手术的患者。分析安全性、可行性和早期结果。使用吗啡当量和视觉模拟疼痛评分（VAPS）评估疼痛参数。
LESS手术包括13例根治性肾切除术（1例双侧）、5例单纯肾切除术（1例双侧）、2例部分肾切除术、2例肾活检和1例肾冷冻消融术。17例肾肿瘤中，15例为肾细胞癌，2例已知肾静脉受累。患者平均年龄为55.4岁，平均体重指数为25.5kg/m²。平均手术时间为131分钟（38 - 230分钟），中位估计失血量为50mL，中位住院时间为2天。有1例术中输血和1例转为传统腹腔镜手术。术后并发症发生率为12%，有2例Clavien分级>2级的并发症。静脉注射麻醉剂的平均吗啡当量剂量为21.7mg，POD#0、#1和出院日的平均VAPS评分分别为4.3、3.5和2.9/10。
LESS手术对于多种肾手术是安全可行的。尽管这项早期经验存在选择偏倚，但术后结果和疼痛评分似乎与标准腹腔镜手术报告的结果相当。需要进行前瞻性研究以比较LESS与标准腹腔镜肾手术，以便进行确定性评估。
