Laparoendoscopic single-site partial nephrectomy: a multi-institutional outcome analysis

Pubblicato da il Mar 18, 2013 in | Commenti disabilitati su Laparoendoscopic single-site partial nephrectomy: a multi-institutional outcome analysis

==inizio abstract==

Introduction and Objective: Laparoendoscopic single-site surgery (LESS) has been developed in an attempt to further reduce the surgical trauma associated with conventional laparoscopy. Partial nephrectomy (PN) represents a challenging indication for LESS. To report a large multi-institutional series of LESS-PN and to analyze the predictors of outcomes in190 consecutive LESS-PN performed between November 2007 and March 2012 at 11 institutions.
Methods: A multivariable analysis was used to assess the factors predicting a short (< 20 min) warm ischemia time (WIT), the occurrence of postoperative complication of any grade, and a “favorable outcome”, arbitrarily defined as a combination of the following events: short WIT + no perioperative complications + negative surgical margins + no conversion to open/laparoscopy. Results: Mean renal tumor size was 2.6, and PADUA score 7.2. Median operative time was 170 min with a median EBL of 150 ml. A clampless technique was adopted in 70 cases (36.8%) and the median WIT was 16.5 min. PADUA score independently predicted length of WIT (low vs high score: OR 5.11, CI 1.50-17.41, p=0.009; intermediate vs high score: OR 5.13, CI 1.56-16.88, p=0.007). The overall postoperative complication rate was 14.7%. The adoption of a robotic LESS technique vs a conventional LESS one (OR 20.92, CI 2.66-164.64, p=0.003) and the occurrence of lower (≤ 250 ml) EBL (OR 3.60, CI 1.35-9.56, p=0.010) were found to be independent predictors of no postoperative complications. A “favorable outcome” was obtained in 83 cases (43.68%) and the only independent predictive factor of a “favorable outcome” was a low PADUA score (OR 4.99, CI 1.98-12.59 p<0.001). Conclusions: LESS-PN can be safely and effectively performed in experienced hands. Patients presenting with low PADUA score tumors represent the best candidates for LESS-PN. The application of a robotic platform is likely to reduce the overall risk of postoperative complications. ==fine abstract==