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Laparoendoscopic Single-Site Pyeloplasty Using Additional 2 mm Instruments: A Comparison with Conventional Laparoscopic Pyeloplasty.

Ju SH, Lee DG, Lee JH, Baek MK, Jeong BC, Jeon SS, Lee KS, Han DH - Korean J Urol (2011)

Bottom Line: But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024).Our initial experiences suggest that LESS-P is a feasible and safe procedure.The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P).

Materials and methods: Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting.

Results: The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months).

Conclusions: Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

No MeSH data available.


Related in: MedlinePlus

A photograph of the operation scar: the single skin incision is often hidden within the umbilicus.
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Figure 4: A photograph of the operation scar: the single skin incision is often hidden within the umbilicus.

Mentions: In this study, LESS-P could be effectively performed compared with CL-P with minimal complications and a low conversion rate. The mean operation time in the LESS group was even shorter than that in the CL-P group (252.2 min vs. 309.7 minutes, p=0.044). However, this may be from the time difference in the operation period. Accumulated experience with intracorporeal suturing may have a decisive effect on the operation time in the LESS group. Despite the time difference, this result demonstrates that LESS-P could be performed effectively by experienced laparoscopic surgeons. LESS-P has a potential cosmetic advantage, but we were unable to assess the cosmetic advantage. Despite inserting a Jackson-Pratt drain at the umbilicus, we effectively hid the surgical scar within the umbilicus during the LESS-P procedure. Furthermore, there were no wound complications in the LEES-P group. It is obvious that a hidden scar has a cosmetic advantage over an exposed CL-P scar (Fig. 4), but further studies with a validated cosmetic scale are necessary to address this issue.


Laparoendoscopic Single-Site Pyeloplasty Using Additional 2 mm Instruments: A Comparison with Conventional Laparoscopic Pyeloplasty.

Ju SH, Lee DG, Lee JH, Baek MK, Jeong BC, Jeon SS, Lee KS, Han DH - Korean J Urol (2011)

A photograph of the operation scar: the single skin incision is often hidden within the umbilicus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3198235&req=5

Figure 4: A photograph of the operation scar: the single skin incision is often hidden within the umbilicus.
Mentions: In this study, LESS-P could be effectively performed compared with CL-P with minimal complications and a low conversion rate. The mean operation time in the LESS group was even shorter than that in the CL-P group (252.2 min vs. 309.7 minutes, p=0.044). However, this may be from the time difference in the operation period. Accumulated experience with intracorporeal suturing may have a decisive effect on the operation time in the LESS group. Despite the time difference, this result demonstrates that LESS-P could be performed effectively by experienced laparoscopic surgeons. LESS-P has a potential cosmetic advantage, but we were unable to assess the cosmetic advantage. Despite inserting a Jackson-Pratt drain at the umbilicus, we effectively hid the surgical scar within the umbilicus during the LESS-P procedure. Furthermore, there were no wound complications in the LEES-P group. It is obvious that a hidden scar has a cosmetic advantage over an exposed CL-P scar (Fig. 4), but further studies with a validated cosmetic scale are necessary to address this issue.

Bottom Line: But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024).Our initial experiences suggest that LESS-P is a feasible and safe procedure.The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P).

Materials and methods: Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting.

Results: The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months).

Conclusions: Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

No MeSH data available.


Related in: MedlinePlus