Is laparoendoscopic single-site surgery a viable approach for radical nephrectomy with renal vein thrombus? Comparison with multiport laparoscopy

Michael A. Liss, Samuel K. Park, Ryan Kopp, Omer A. Raheem, Wassim M. Bazzi, Reza Mehrazin, Kerrin L. Palazzi, Sean P. Stroup, Ithaar H. Derweesh

Research output: Contribution to journalArticle

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Abstract

Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)105-110
Number of pages6
JournalUrology
Volume82
Issue number1
DOIs
StatePublished - Jul 2013
Externally publishedYes

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Renal Veins
Nephrectomy
Laparoscopy
Thrombectomy
Thrombosis
Pain
Length of Stay
Demography
Neoplasms
Kidney Neoplasms
Narcotics
Operative Time
Surgical Instruments
Disease-Free Survival
Kidney

ASJC Scopus subject areas

  • Urology

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Is laparoendoscopic single-site surgery a viable approach for radical nephrectomy with renal vein thrombus? Comparison with multiport laparoscopy. / Liss, Michael A.; Park, Samuel K.; Kopp, Ryan; Raheem, Omer A.; Bazzi, Wassim M.; Mehrazin, Reza; Palazzi, Kerrin L.; Stroup, Sean P.; Derweesh, Ithaar H.

In: Urology, Vol. 82, No. 1, 07.2013, p. 105-110.

Research output: Contribution to journalArticle

Liss, Michael A. ; Park, Samuel K. ; Kopp, Ryan ; Raheem, Omer A. ; Bazzi, Wassim M. ; Mehrazin, Reza ; Palazzi, Kerrin L. ; Stroup, Sean P. ; Derweesh, Ithaar H. / Is laparoendoscopic single-site surgery a viable approach for radical nephrectomy with renal vein thrombus? Comparison with multiport laparoscopy. In: Urology. 2013 ; Vol. 82, No. 1. pp. 105-110.
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T1 - Is laparoendoscopic single-site surgery a viable approach for radical nephrectomy with renal vein thrombus? Comparison with multiport laparoscopy

AU - Liss, Michael A.

AU - Park, Samuel K.

AU - Kopp, Ryan

AU - Raheem, Omer A.

AU - Bazzi, Wassim M.

AU - Mehrazin, Reza

AU - Palazzi, Kerrin L.

AU - Stroup, Sean P.

AU - Derweesh, Ithaar H.

PY - 2013/7

Y1 - 2013/7

N2 - Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

AB - Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

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