Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
Eur Urol. 2012 Oct;62(4):601-12. doi: 10.1016/j.eururo.2012.05.055. Epub 2012 Jun 6.
Laparoendoscopic single-site (LESS) surgery has increasingly been used to perform radical, partial, simple, or donor nephrectomy to reduce the morbidity and scarring associated with surgical intervention. Studies comparing LESS nephrectomy (LESS-N) and conventional laparoscopic nephrectomy (CL-N) have reported conflicting results.
To assess the current evidence regarding the efficiency, safety, and potential advantages of LESS-N compared with CL-N.
We comprehensively searched PubMed, Embase, and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the two techniques.
Two RCTs and 25 retrospective studies including a total of 1094 cases were identified. Although LESS-N was associated with a longer operative time (weighted mean difference [WMD]: 9.87 min; 95% confidence interval [CI], 3.37-16.38; p=0.003) and a higher conversion rate (6% compared with 0.3%; odds ratio: 4.83; 95% CI, 1.87-12.45; p=0.001), patients in this group might benefit from less postoperative pain (WMD: -0.48; 95% CI, -0.95 to -0.02; p=0.04), lower analgesic requirement (WMD: -4.78 mg; 95% CI, -8.59 to -0.97; p=0.01), shorter hospital stay (WMD: -0.32 d; 95% CI, -0.55 to -0.09; p=0.007), shorter recovery time (WMD: -5.08 d; 95% CI, -8.49 to -1.68; p=0.003), and better cosmetic outcome (WMD: 1.07; 95% CI, 0.67-1.48; p<0.00001). Perioperative complications, estimated blood loss, warm ischemia time, and postoperative serum creatinine levels of graft recipients did not differ significantly between techniques.
LESS-N offers a safe and efficient alternative to CL-N with less pain, shorter recovery time, and better cosmetic outcome. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis.
经腹腔镜单部位（LESS）手术越来越多地用于进行根治性、部分性、简单性或供体肾切除术，以降低与手术干预相关的发病率和疤痕形成。比较 LESS 肾切除术（LESS-N）和传统腹腔镜肾切除术（CL-N）的研究报告结果相互矛盾。
评估 LESS-N 与 CL-N 相比在效率、安全性和潜在优势方面的现有证据。
我们全面检索了 PubMed、Embase 和 Cochrane 图书馆，并对所有随机对照试验（RCT）和评估这两种技术的回顾性比较研究进行了系统评价和累积荟萃分析。
确定了两项 RCT 和 25 项回顾性研究，共纳入 1094 例病例。尽管 LESS-N 手术时间较长（加权均数差[WMD]：9.87 分钟；95%置信区间[CI]，3.37-16.38；p=0.003），且转换率较高（6%比 0.3%；比值比：4.83；95%CI，1.87-12.45；p=0.001），但该组患者术后疼痛可能较轻（WMD：-0.48；95%CI，-0.95 至-0.02；p=0.04），镇痛需求较低（WMD：-4.78 毫克；95%CI，-8.59 至-0.97；p=0.01），住院时间较短（WMD：-0.32 天；95%CI，-0.55 至-0.09；p=0.007），恢复时间较短（WMD：-5.08 天；95%CI，-8.49 至-1.68；p=0.003），且美容效果更好（WMD：1.07；95%CI，0.67-1.48；p<0.00001）。两种技术之间，围手术期并发症、估计失血量、热缺血时间和移植肾受者术后血清肌酐水平无显著差异。
LESS-N 是 CL-N 的一种安全有效的替代方法，具有疼痛较轻、恢复时间较短和美容效果较好的优点。鉴于纳入研究的固有局限性，需要未来设计良好的 RCT 来证实和更新本分析的结果。
