Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA.
Urology. 2013 Jul;82(1):105-10. doi: 10.1016/j.urology.2013.01.075. Epub 2013 May 25.
To compare laparoendoscopic single-site surgery (LESS) and multiport laparoscopy (MPL) for radical nephrectomy and renal vein thrombectomy (RN-RVT) because concerns continue regarding the suitability of LESS for advanced renal tumors.
We initiated a retrospective analysis of 26 patients who underwent RN-RVT (11 LESS, 15 MPL) between January 2006 and September 2011. LESS transperitoneal access was obtained by a periumbilical incision through which all trocars were inserted. LESS-RN-RVT recapitulated steps of MPL-RN-RVT, including stapled RVT and intact specimen extraction. Demographic factors and tumor characteristics, perioperative variables, and complications and outcomes were analyzed. Primary outcome was discharge visual analog pain score.
Median follow-up was 20.8 months. The 15 MPL cases were successfully completed laparoscopically; 1 of 11 LESS cases required insertion of an additional 5-mm port at a separate site. There were no significant demographic differences between the 2 groups. For LESS-RN-RVT and MPL-RN-RVT, mean tumor diameter was 7.1 and 7.9 cm (P = .346), mean RENAL nephrometry score was 10.2 and 10.5 (P = .407), mean operative time was 147 and 161 minutes (P = .331), and mean estimated blood loss was 122 and 170 mL (P = .282). Significantly lower visual analog pain score at discharge (1.1 vs 2.7, P = .001), narcotic requirement (8.3 vs 14 mg, P = .049), and hospital stay (2.6 vs 3.7 days, P = .032) were noted for LESS vs MPL patients. Both groups had negative margins. There were no significant differences in complications or transfusions or in disease-free and overall survival.
LESS was comparable to MPL-RN-RVT for perioperative parameters and may confer benefit with pain and hospital stay. Further study is requisite to establish the role of LESS in the management of renal neoplasms with RVT.
比较腹腔镜单部位手术（LESS）和多孔腹腔镜（MPL）在根治性肾切除术和肾静脉血栓切除术（RN-RVT）中的应用，因为人们仍然担心 LESS 是否适用于晚期肾肿瘤。
我们对 2006 年 1 月至 2011 年 9 月期间接受 RN-RVT 的 26 例患者（11 例 LESS，15 例 MPL）进行了回顾性分析。LESS 经腹腔入路通过脐部切口获得，所有trocar 均通过该切口插入。LESS-RN-RVT 重现了 MPL-RN-RVT 的步骤，包括吻合 RVT 和完整标本提取。分析了人口统计学因素和肿瘤特征、围手术期变量以及并发症和结局。主要结局是出院视觉模拟疼痛评分。
中位随访时间为 20.8 个月。15 例 MPL 病例均成功完成腹腔镜手术；11 例 LESS 病例中有 1 例需要在另一个部位插入一个额外的 5mm 端口。两组间无显著的人口统计学差异。对于 LESS-RN-RVT 和 MPL-RN-RVT，肿瘤直径的平均值分别为 7.1cm 和 7.9cm（P=0.346），肾单位评分的平均值分别为 10.2 和 10.5（P=0.407），手术时间的平均值分别为 147 分钟和 161 分钟（P=0.331），估计失血量的平均值分别为 122ml 和 170ml（P=0.282）。LESS 组出院时视觉模拟疼痛评分明显较低（1.1 对 2.7，P=0.001），阿片类药物需求（8.3 对 14mg，P=0.049）和住院时间（2.6 对 3.7 天，P=0.032）也较低。两组均有阴性切缘。两组并发症、输血、无病生存率和总生存率无显著差异。
LESS 与 MPL-RN-RVT 在围手术期参数方面具有可比性，并且可能通过减轻疼痛和缩短住院时间带来获益。进一步的研究是必要的，以确定 LESS 在管理伴有 RVT 的肾肿瘤中的作用。
