Laparoendoscopic single‐site versus conventional transperitoneal laparoscopic pyeloplasty: A prospective randomized study

Abstract

Abbreviations & Acronyms 99mTc-DTPA = technetium99m-diethylene triamine pentaacetic acid BMI = body mass index CTL-P = conventional transperitoneal laparoscopic pyeloplasty LESS = laparoendoscopic single site LESS-P = laparoendoscopic single site pyeloplasty UPJO = ureteropelvic junction obstruction VAS = visual analog scale Objectives: To evaluate the potential benefits of laparoendoscopic single-site pyeloplasty over conventional laparoscopic pyeloplasty. Methods: Between October 2009 and January 2012, 39 patients were enrolled in a prospective study and randomized to undergo a laparoendoscopic single-site pyeloplasty (n = 19) or conventional laparoscopic pyeloplasty (n = 20). The outcomes in the two groups were compared by using Mann-Whitney U-test and c 2 -test, and considering a P-value less than 0.05 as statistically significant. Results: There was no difference in blood loss (55.67 Ϯ 6.71 vs 45.84 Ϯ 5.22 mL, P = 0.60), transfusion rates (0% for both) and hospitalization time (2.12 Ϯ 0.23 vs 2.06 Ϯ 0.34 days, P = 0.72) between the laparoendoscopic single-site pyeloplasty and conventional laparoscopic pyeloplasty groups. The time to return to normal activities was shorter (8.65 Ϯ 1.25 vs 11.53 Ϯ 1.28 days, P = 0.01), and median operative time (195.21 Ϯ 12.15 vs 145.62 Ϯ 15.34 min, P = 0.001) was longer in the laparoendoscopic single-site pyeloplasty group compared with the conventional laparoscopic pyeloplasty group. No significant intraoperative or postoperative complications occurred in either group. Compared with conventional laparoscopic pyeloplasty, laparoendoscopic singlesite pyeloplasty yielded better cosmetic results and patient satisfaction. The mean follow-up period was 19.7 months (4-28 months). The success rate was 95% in both the groups. Both the visual analog scale and the postoperative use of analgesics were significantly lower in patients who underwent laparoendoscopic single-site pyeloplasty. Conclusions: Our findings suggest that laparoendoscopic single-site pyeloplasty can offer faster recovery and higher patient satisfaction than conventional laparoscopic pyeloplasty. Thus, this novel technique promises to become the treatment of choice in minimally-invasive management of ureteropelvic junction obstruction.

Laparoendoscopic single site surgery versus conventional laparoscopy for transperitoneal pyeloplasty: A systematic review and meta-analysis

“…Two of them compared consecutive series (LE]: 3b);[ 13 21 ] one performed a retrospective nonconsecutive study (LE: 4);[ 22 ] one compared a matched cohort (LE: 3a)[ 23 ] one of them was a prospective RCT (LE: 2b). [ 24 ] The methodological quality of the retrospective studies was relatively high, with all the studies reporting at least 7 out of 9 stars, but with a low LE between 3 and 4. Nevertheless, the only RCT study was graded as low quality, reporting 2 out of 5 points [ Table 1 ].…”

Laparoendoscopic single‐site surgeries: A multicenter experience of 469 cases in Japan

“…According to this synthesizing evidence, LESS surgery is expected to reduce the morbidity and scarring associated with surgical intervention. Nevertheless, these reports were mostly based on small‐scale studies from selected centers . Therefore, it is difficult to regard LESS surgery as an ideal standard procedure across institutional boundaries.…”

“…Several RCTs of urological LESS surgeries compared with conventional laparoscopic procedures were reported. The reported RCTs, including varicocelectomy, 18,19 pyeloplasty, 20 simple nephrectomy 21 and living donor nephrectomy, [22][23][24] although these were relatively small series, suggested that the 18,20,21 and the postoperative pain [18][19][20][21][22][23] were lower, and the time to return to normal activities was shorter [18][19][20][21]24 in the LESS group. Nevertheless, the operative time in the LESS group was longer 18,19,[21][22][23][24] or, at best, equivalent to the conventional group.…”

“…Nevertheless, the operative time in the LESS group was longer 18,19,[21][22][23][24] or, at best, equivalent to the conventional group. 20 Currently, there are three meta-analysis reports about urological LESS surgery. [25][26][27] Fan et al reported a systematic review and meta-analysis of LESS nephrectomy compared with conventional laparoscopic nephrectomy, and the LESS nephrectomy was associated with a longer operative time and a higher conversion rate.…”

“…Nevertheless, these reports were mostly based on small-scale studies from selected centers. [18][19][20][21][22][23][24][25][26][27] Therefore, it is difficult to regard LESS surgery as an ideal standard procedure across institutional boundaries. Whether this technique can be used not only by experts in high-volume centers, but also by experienced surgeons in nonhigh-volume centers, is a key to the future of LESS surgery as a promising technique in urology.…”