Laparo-Endoscopic Single Site (LESS) versus Standard Laparoscopic Left Donor Nephrectomy: Matched-pair Comparison

被引:198
作者
Canes, David [2 ]
Berger, Andre [3 ]
Aron, Monish [3 ]
Brandina, Ricardo [3 ]
Goldfarb, David A. [3 ]
Shoskes, Daniel [3 ]
Desai, Mihir M. [3 ]
Gill, Inderbir S. [1 ]
机构
[1] Univ So Calif, Keck Sch Med, USC Inst Urol, Los Angeles, CA 90089 USA
[2] Lahey Clin Fdn, Dept Urol, Burlington, MA USA
[3] Cleveland Clin, Dept Urol, Cleveland, OH 44106 USA
关键词
Single port; Laparoscopy; Donor nephrectomy; Laparo-Endoscopic Single Site (LESS) surgery; OUTCOMES; SURGERY; RECIPIENTS; INCISIONS;
D O I
10.1016/j.eururo.2009.07.023
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Laparo-Endoscopic Single Site (LESS) surgery is a recent development in minimally invasive surgery. Presented herein is the initial comparison of LESS donor nephrectomy (LESS-DN) and standard laparoscopic living donor nephrectomy (LLDN). Objective: To determine whether LESS-DN provides any measurable benefit over LLDN during the perioperative period and subsequent convalescence. Design, setting, and participants: Between November 2007 and November 2008, 18 consecutive patients underwent LESS-DN (17 left DN, 1 right DN). A contemporary matched-pair cohort of 17 patients undergoing standard LLDN was selected for retrospective comparison. Interventions: LESS-DN was performed through an intraumbilical novel multichannel port. The kidney was extracted through a slightly extended umbilical incision. Measurements: All data were prospectively accrued in an institutional review board-approved database. Convalescence data included visual analog pain scores and questionnaires containing patient-reported time to recovery end points. Results and limitations: One right-sided donor was converted to standard laparoscopy and excluded from analysis. Baseline demographics, operating time, blood loss, and hospital stay were comparable between groups. Compared to LLDN, patients undergoing LESS-DN had similar in-hospital analgesic requirements and mean visual analog scores at discharge. After discharge, patient-reported convalescence was faster in the LESS-DN group, including days on oral pain medication (20 vs 6; p = 0.01), days off work (46 vs 18; p = 0.0009), and days to 100% physical recovery (83 vs 29; p = 0.03). Mean warm ischemia time was longer in the LESS-DN group (3 vs 6.1 min; p < 0.0001); however, allograft function was immediate and comparable between groups. One allograft in the LESS-DN group thrombosed postoperatively. Regardless of laparoscopic approach, patients' global satisfaction with kidney donation and willingness to recommend their procedure to others were favorable and equivalent between groups. Conclusions: This retrospective matched-pair comparison between LESS-DN and LLDN suggests that the single-port approach may be associated with quicker convalescence. In this initial series, LESS-DN had longer ischemia time, yet early allograft outcomes were comparable. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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收藏
页码:95 / 101
页数:7
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