Single-site laparoscopic partial nephrectomy:Where are we going?

• 作者: Fabio Pellegrini Francesco Berardinelli Guido Giusti Luca Cindolo Luigi Schips Mario Alvaréz-Maestro Roberto Castellucci
• 来源期刊: 世界临床泌尿杂志
• 学科: 医学
• 关键词: NEPHRON sparing SURGERY PARTIAL NEPHRECTOMY Laparoendoscopic SINGLE-SITE SURGERY SINGLE-PORT access SURGERY Single-incision laparoscopic SURGERY Robotic SINGLE-PORT PARTIAL NEPHRECTOMY
• 年，卷（期）: sjlcmnzz_2014,（3）
• 页码范围: 358-363
• 页数: 6页
• 分类号: R

摘要

AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubMed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221 patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6 min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.