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For: Flamand V, Sanchez-Salas R, Galiano M, Rozet F, Cathelineau X, Barret E, Vallancien G. V3 LESS RADICAL NEPHRECTOMY. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1569-9056(11)61092-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

For:	Flamand V, Sanchez-Salas R, Galiano M, Rozet F, Cathelineau X, Barret E, Vallancien G. V3 LESS RADICAL NEPHRECTOMY. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1569-9056(11)61092-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

Number	Cited by Other Article(s)
1	Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol 2012;62:601-12. [PMID: 22704730 DOI: 10.1016/j.eururo.2012.05.055] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 05/28/2012] [Indexed: 02/08/2023] Abstract CONTEXT Laparoendoscopic single-site (LESS) surgery has increasingly been used to perform radical, partial, simple, or donor nephrectomy to reduce the morbidity and scarring associated with surgical intervention. Studies comparing LESS nephrectomy (LESS-N) and conventional laparoscopic nephrectomy (CL-N) have reported conflicting results. OBJECTIVE To assess the current evidence regarding the efficiency, safety, and potential advantages of LESS-N compared with CL-N. EVIDENCE ACQUISITION We comprehensively searched PubMed, Embase, and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the two techniques. EVIDENCE SYNTHESIS Two RCTs and 25 retrospective studies including a total of 1094 cases were identified. Although LESS-N was associated with a longer operative time (weighted mean difference [WMD]: 9.87 min; 95% confidence interval [CI], 3.37-16.38; p=0.003) and a higher conversion rate (6% compared with 0.3%; odds ratio: 4.83; 95% CI, 1.87-12.45; p=0.001), patients in this group might benefit from less postoperative pain (WMD: -0.48; 95% CI, -0.95 to -0.02; p=0.04), lower analgesic requirement (WMD: -4.78 mg; 95% CI, -8.59 to -0.97; p=0.01), shorter hospital stay (WMD: -0.32 d; 95% CI, -0.55 to -0.09; p=0.007), shorter recovery time (WMD: -5.08 d; 95% CI, -8.49 to -1.68; p=0.003), and better cosmetic outcome (WMD: 1.07; 95% CI, 0.67-1.48; p<0.00001). Perioperative complications, estimated blood loss, warm ischemia time, and postoperative serum creatinine levels of graft recipients did not differ significantly between techniques. CONCLUSIONS LESS-N offers a safe and efficient alternative to CL-N with less pain, shorter recovery time, and better cosmetic outcome. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis. Collapse Key Words Collapse MESH Headings Collapse Grants Collapse Affiliation(s) Collapse

Number

Cited by Other Article(s)

Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol 2012;62:601-12. [PMID: 22704730 DOI: 10.1016/j.eururo.2012.05.055] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 05/28/2012] [Indexed: 02/08/2023]

Abstract

CONTEXT

Laparoendoscopic single-site (LESS) surgery has increasingly been used to perform radical, partial, simple, or donor nephrectomy to reduce the morbidity and scarring associated with surgical intervention. Studies comparing LESS nephrectomy (LESS-N) and conventional laparoscopic nephrectomy (CL-N) have reported conflicting results.

OBJECTIVE

To assess the current evidence regarding the efficiency, safety, and potential advantages of LESS-N compared with CL-N.

EVIDENCE ACQUISITION

We comprehensively searched PubMed, Embase, and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the two techniques.

EVIDENCE SYNTHESIS

Two RCTs and 25 retrospective studies including a total of 1094 cases were identified. Although LESS-N was associated with a longer operative time (weighted mean difference [WMD]: 9.87 min; 95% confidence interval [CI], 3.37-16.38; p=0.003) and a higher conversion rate (6% compared with 0.3%; odds ratio: 4.83; 95% CI, 1.87-12.45; p=0.001), patients in this group might benefit from less postoperative pain (WMD: -0.48; 95% CI, -0.95 to -0.02; p=0.04), lower analgesic requirement (WMD: -4.78 mg; 95% CI, -8.59 to -0.97; p=0.01), shorter hospital stay (WMD: -0.32 d; 95% CI, -0.55 to -0.09; p=0.007), shorter recovery time (WMD: -5.08 d; 95% CI, -8.49 to -1.68; p=0.003), and better cosmetic outcome (WMD: 1.07; 95% CI, 0.67-1.48; p<0.00001). Perioperative complications, estimated blood loss, warm ischemia time, and postoperative serum creatinine levels of graft recipients did not differ significantly between techniques.

CONCLUSIONS

LESS-N offers a safe and efficient alternative to CL-N with less pain, shorter recovery time, and better cosmetic outcome. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis.

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