Department of Surgery/Division of Urology, University of California, San Diego School of Medicine, La Jolla, CA 90293-0987, USA.
Urology. 2012 Nov;80(5):1039-45. doi: 10.1016/j.urology.2012.07.018. Epub 2012 Sep 15.
To prospectively compare outcomes of laparoendoscopic single-site and multiport laparoscopic radical nephrectomy and partial nephrectomy, focusing on postoperative pain and analgesic requirement.
Nonrandomized, prospective comparison of laparoendoscopic single-site and multiport laparoscopic radical nephrectomy and partial nephrectomy. Thirty-four patients underwent laparoendoscopic single-site (17 radical nephrectomy/17 partial nephrectomy); 42 underwent multiport laparoscopy (28 radical nephrectomy/14 partial nephrectomy) from February 2009 to February 2010. Laparoendoscopic single-site transperitoneal access was obtained by periumbilical incision through which all trocars were inserted. Laparoendoscopic radical nephrectomy/partial nephrectomy recapitulated steps of multiport laparoscopic radical nephrectomy/partial nephrectomy. Demographics/tumor characteristics, outcomes, and complications were analyzed.
Forty-two of 42 multiport laparoscopic and 32/34 laparoendoscopic single-site cases were successfully performed. Mean follow-up was 16.2 months. For laparoendoscopic single-site and multiport laparoscopy groups mean operating room time (min) was 159.3 vs 158.9 (P = .952); mean estimated blood loss (mL) was 175.7 vs 156.1 (P = .553); percent transfused was 2.9% vs 0% (P = .925). No significant differences in complications were noted (P = .745). Significant decrease in analgesic use (6 morphine equivalents vs 11.6, P < .001) and discharge pain score (1.7 vs 2.7, P < .01) were noted in laparoendoscopic single-site vs multiport laparoscopic radical nephrectomy. For laparoendoscopic single-site partial nephrectomy and multiport laparoscopic partial nephrectomy, no significant differences were noted for tumor diameter (1.8 vs 2.0 cm, P = .57), RENAL score (0.962), ischemia time (28.6 vs 27.5 minutes, P = .70), and preoperative (P = .78)/postoperative creatinine (P = .32). For laparoendoscopic single-site radical nephrectomy and multiport laparoscopic radical nephrectomy, no significant differences were noted for mean tumor diameter (5.6 vs 5.3 cm, P = .63), RENAL score (P = .815), and mean operative time (142.3 vs 155.4 minutes P = .13).
In this well-matched, prospective comparison, laparoendoscopic single-site is comparable with multiport laparoscopic surgery in terms of perioperative parameters and may confer benefit with respect to analgesic requirement. Randomized evaluation and longer-term follow-up are necessary.
前瞻性比较经腹腔镜单孔与多孔腹腔镜根治性肾切除术和部分肾切除术的结果，重点关注术后疼痛和镇痛需求。
非随机、前瞻性比较经腹腔镜单孔与多孔腹腔镜根治性肾切除术和部分肾切除术。34 例患者接受了经腹腔镜单孔（17 例根治性肾切除术/17 例部分肾切除术）；42 例患者接受了多孔腹腔镜手术（28 例根治性肾切除术/14 例部分肾切除术），时间为 2009 年 2 月至 2010 年 2 月。经腹腔镜单孔经脐部切口获得经腹腔镜单孔经腹腔镜单孔入路，所有套管均通过该切口插入。经腹腔镜根治性肾切除术/部分肾切除术概括了多孔腹腔镜根治性肾切除术/部分肾切除术的步骤。分析人口统计学/肿瘤特征、结果和并发症。
42 例多孔腹腔镜和 34 例经腹腔镜单孔手术均成功完成。平均随访时间为 16.2 个月。对于经腹腔镜单孔和多孔腹腔镜组，平均手术时间（分钟）分别为 159.3 比 158.9（P =.952）；平均估计失血量（毫升）分别为 175.7 比 156.1（P =.553）；输血比例分别为 2.9%比 0%（P =.925）。两组并发症无显著差异（P =.745）。经腹腔镜单孔组的镇痛药物使用量（6 吗啡当量比 11.6，P <.001）和出院疼痛评分（1.7 比 2.7，P <.01）显著降低。对于经腹腔镜单孔部分肾切除术和多孔腹腔镜部分肾切除术，肿瘤直径（1.8 比 2.0cm，P =.57）、RENAL 评分（0.962）、缺血时间（28.6 比 27.5 分钟，P =.70）和术前（P =.78）/术后肌酐（P =.32）无显著差异。对于经腹腔镜单孔根治性肾切除术和多孔腹腔镜根治性肾切除术，平均肿瘤直径（5.6 比 5.3cm，P =.63）、RENAL 评分（P =.815）和平均手术时间（142.3 比 155.4 分钟，P =.13）无显著差异。
在这项精心匹配的前瞻性比较中，经腹腔镜单孔与多孔腹腔镜手术在围手术期参数方面具有可比性，并且在镇痛需求方面可能具有优势。需要随机评估和更长时间的随访。
