"S. Pio da Pietrelcina" Hospital, Department of Urology, Vasto (CH), Italy.
Eur Urol. 2013 Apr;63(4):759-65. doi: 10.1016/j.eururo.2012.08.008. Epub 2012 Aug 15.
Laparoendoscopic single-site surgery (LESS) has emerged as a natural progression from standard laparoscopy aiming to further minimize the morbidity of urologic procedures.
To describe our technique and report the surgical and functional outcomes of unclamped LESS partial nephrectomy (PN) in the treatment of small renal masses (SRMs).
DESIGN, SETTING, AND PARTICIPANTS: Prospective evaluation of pre- and postoperative variables of patients undergoing the LESS-PN without ischemia between 2009 and 2012. The indications were single exophytic SRMs.
Unclamped LESS-PN was performed through a transperitoneal approach. A pararectal Hasson access technique was preferred. Single-port access was achieved via different single-port devices. A combination of straight and articulating laparoscopic instruments was used. The tumor was excised using bipolar scissors during normal renal perfusion. Hemostasis was achieved by bipolar electrocautery, parenchymal stitches, and hemostatic agents.
Demographic, operative, postoperative, and pathologic outcomes data were recorded and analyzed.
A total of 21 LESS-PN were performed (operative time: 111 ± 41 min; blood loss: 196 ± 195 ml: tumor size: 2.0 ± 0.3 cm). Neither conversion to open surgery nor transfusions occurred. Three patients required conversion to standard laparoscopy. Postoperatively, three complications (Clavien grades 2, 3a, and 4) were recorded. Pathologic examination revealed 14 clear cell carcinomas, four renal cysts, two oncocytomas, and one angiomyolipoma. Hospital stay was 4.4 ± 1.9 d. At the last follow-up (mean: 17±11.5 mo), no port-site, local, or distant recurrences were detected. No significant variation in serum creatinine and estimated glomerular filtration rate was observed. Subjective scar evaluation indicated 66% of patients were very satisfied/enthusiastic. Study limitations include the small sample size, the lack of a control group, the short follow-up period, and the arbitrary measure of patient's scar perception.
Unclamped LESS-PN for selected SRMs is a safe and feasible procedure providing favorable postoperative outcomes and ensuring high levels of subjective, cosmetic satisfaction.
腹腔镜单部位手术（LESS）作为一种从标准腹腔镜发展而来的自然进步，旨在进一步降低泌尿科手术的发病率。
描述我们的技术，并报告无夹闭腹腔镜单部位部分肾切除术（LESS-PN）治疗小肾肿瘤（SRM）的手术和功能结果。
设计、地点和参与者：对 2009 年至 2012 年间行无缺血LESS-PN 的患者的术前和术后变量进行前瞻性评估。适应证为单发外生 SRM。
经腹腔途径行无夹闭 LESS-PN。首选旁直肠 Hasson 入路技术。单端口通道通过不同的单端口设备实现。使用直型和关节型腹腔镜器械的组合。在正常的肾脏灌注下使用双极剪刀切除肿瘤。使用双极电凝、实质缝合和止血剂止血。
记录并分析了人口统计学、手术、术后和病理结果数据。
共行 21 例 LESS-PN（手术时间：111±41 分钟；出血量：196±195ml；肿瘤大小：2.0±0.3cm）。无中转开放手术或输血。3 例患者需要中转标准腹腔镜。术后有 3 例并发症（Clavien 分级 2、3a 和 4）。病理检查显示 14 例透明细胞癌、4 例肾囊肿、2 例嗜酸细胞瘤和 1 例血管平滑肌脂肪瘤。住院时间为 4.4±1.9 天。末次随访（平均：17±11.5 个月）时，未发现切口、局部或远处复发。血清肌酐和估算肾小球滤过率无明显变化。主观瘢痕评估显示 66%的患者非常满意/热情。研究局限性包括样本量小、缺乏对照组、随访时间短以及患者瘢痕感知的任意测量。
对于选定的 SRM，无夹闭 LESS-PN 是一种安全可行的手术方法，可提供良好的术后结果，并确保高水平的主观美容满意度。
