Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
J Endourol. 2012 Jun;26(6):676-81. doi: 10.1089/end.2011.0161. Epub 2011 Oct 21.
The aim of this study is to compare the perioperative outcomes after transumbilical laparoendoscopic single-site (LESS) radical nephrectomy (LESS-RN) performed by a surgeon during his learning curve of this novel procedure with the outcomes after standard laparoscopic radical nephrectomy (LRN) for patients with a solitary renal tumor. Using this information, we examined whether LESS exhibits any objective advantages over standard laparoscopy.
Twenty patients who underwent LESS-RN for a solitary cT(1)N(0)M(0) renal mass (group 1) were matched and compared with 33 patients who underwent standard LRN (group 2) for tumors of similar sizes. Patient and surgical data, pathologic outcomes, and follow-up information, including patient responses regarding cosmetic satisfaction, were analyzed.
The minimum duration of follow-up was 6 months for both groups. Patients in group 1 had significantly (P<0.05) quicker recoveries of bowel function, shorter postoperative analgesic time, and lower pain scores during their hospital stay. At the time of the last follow-up, all patients remained symptom free, and no evidence of recurrence was detected. Compared with that of standard LRN patients, LESS-RN patients exhibited better cosmetic satisfaction scores postoperatively at least to 6 months (P=0.013).
Transumbilical LESS-RN is a feasible, safe, and efficacious procedure with favorable perioperative outcomes that results in significantly improved control of postoperative pain, more rapid recovery of bowel function, and increased cosmetic satisfaction. Additional research, including randomized controlled trials and long-term follow-ups, however, will be needed to draw solid conclusions regarding the relative efficacy of this procedure compared with standard approaches.
本研究旨在比较在该新术式学习曲线期间由外科医生进行的经脐腹腔镜单部位（LESS）根治性肾切除术（LESS-RN）与用于治疗单个肾肿瘤患者的标准腹腔镜根治性肾切除术（LRN）的围手术期结果。利用这些信息，我们检查了LESS 是否相对于标准腹腔镜具有任何客观优势。
20 例接受 LESS-RN 治疗的单个 cT(1)N(0)M(0)肾肿瘤患者（组 1）与 33 例接受标准 LRN 治疗的肿瘤大小相似的患者（组 2）进行匹配和比较。分析患者和手术数据、病理结果以及随访信息，包括患者对美容满意度的回复。
两组患者的随访时间均至少为 6 个月。组 1 患者的肠道功能恢复、术后镇痛时间和住院期间疼痛评分明显（P<0.05）更快。在最后一次随访时，所有患者均无症状，未发现复发迹象。与标准 LRN 患者相比，LESS-RN 患者至少在术后 6 个月时表现出更好的美容满意度评分（P=0.013）。
经脐LESS-RN 是一种可行、安全、有效的手术方法，具有良好的围手术期结果，可显著改善术后疼痛控制、更快恢复肠道功能和提高美容满意度。然而，需要进行更多的研究，包括随机对照试验和长期随访，才能得出关于该术式与标准方法相比的相对疗效的可靠结论。
