Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
J Endourol. 2011 Dec;25(12):1859-65. doi: 10.1089/end.2011.0015. Epub 2011 Oct 27.
The aim is to report our 1-year experience in transumbilical Laparoendoscopic single-site (LESS) radical nephrectomy (LESS-RN) and assess its learning curve.
From September 2009 to December 2010, 18 consecutive patients with a solitary renal tumor underwent transumbilical LESS-RN. We grouped measured parameters on the basis of the first nine (group A) and last nine (group B) patients, and compared both subgroups with the control group (C), which was composed of the initial nine consecutive patients who underwent conventional laparoscopic RNs performed by the same surgeon.
There was one LESS patient converted to conventional laparoscopic surgery for intraoperative hemorrhage and transfused. The mean for measured parameters of the groups A, B, C were: age: 58.6, 57.2, and 59.2 years, respectively (P>0.05); American Society of Aneshesiologists score: 1.9, 2.0, and 2.0, respectively (P>0.05); body mass index: 25.2, 23.5, and 23.1 kg/m(2), respectively (P>0.05); lesion size at CT scan: 5.0, 4.6, and 6.2 cm, respectively (P=0.039); operative skin to skin time: 191.6, 123.9, and 122.2 minutes, respectively (P=0.000); estimated blood loss: 172.2, 246.7, and 116.7 mL, respectively (P>0.05); incision length: 5.6, 5.9, and 7.4 cm, respectively (P=0.000); hospital stay: 5.8, 5.8, and 5.8 days, respectively (P>0.05). At the latest follow-up, all patients did not present any local recurrence or metastasis.
In selected patients, the transumbilical LESS-RN can be safely performed with favorable outcomes. While a learning curve certainly exists, it appears to be short for an experienced laparoscopic surgeon.
报告我们在经脐腹腔镜单部位（LESS）根治性肾切除术（LESS-RN）方面的 1 年经验，并评估其学习曲线。
从 2009 年 9 月至 2010 年 12 月，连续 18 例孤立性肾肿瘤患者接受了经脐LESS-RN。我们根据前 9 例（A 组）和后 9 例（B 组）患者的测量参数进行分组，并将这两个亚组与同一术者进行的初始 9 例常规腹腔镜 RNs 的对照组（C 组）进行比较。
有 1 例 LESS 患者因术中出血转为常规腹腔镜手术，并输血。组 A、B、C 的平均测量参数分别为：年龄：58.6、57.2 和 59.2 岁（P＞0.05）；美国麻醉师协会评分：1.9、2.0 和 2.0（P＞0.05）；体重指数：25.2、23.5 和 23.1 kg/m(2)，分别（P＞0.05）；CT 扫描时的病变大小：5.0、4.6 和 6.2 cm，分别（P=0.039）；手术皮肤到皮肤时间：191.6、123.9 和 122.2 分钟，分别（P=0.000）；估计失血量：172.2、246.7 和 116.7 mL，分别（P＞0.05）；切口长度：5.6、5.9 和 7.4 cm，分别（P=0.000）；住院时间：5.8、5.8 和 5.8 天，分别（P＞0.05）。在最新的随访中，所有患者均未出现局部复发或转移。
在选择的患者中，经脐LESS-RN 可以安全进行，且结果良好。虽然确实存在学习曲线，但对于有经验的腹腔镜外科医生来说，它似乎很短。
