Robotic Laparoendoscopic Single-Site Radical Nephrectomy: Surgical Technique and Comparative Outcomes

• Published in: European urology Vol. 59; no. 5; pp. 815 - 822
• Main Authors: White, Michael A, Autorino, Riccardo, Spana, Gregory, Laydner, Humberto, Hillyer, Shahab P, Khanna, Rakesh, Yang, Bo, Altunrende, Fatih, Isac, Wahib, Stein, Robert J, Haber, Georges-Pascal, Kaouk, Jihad H
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01-05-2011
• Subjects: Aged; Analgesics, Opioid - therapeutic use; Blood Loss, Surgical; Case-Control Studies; Equipment Design; Feasibility Studies; Female; Humans; Kidney cancer; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Laparoscopes; Laparoscopy - adverse effects; Laparoscopy - instrumentation; Length of Stay; LESS; Male; Middle Aged; Neoplasm Staging; Nephrectomy - adverse effects; Nephrectomy - instrumentation; Nephrectomy - methods; Ohio; Outcome and Process Assessment (Health Care) - statistics & numerical data; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Patient Positioning; Radical nephrectomy; Retrospective Studies; Robotic; Robotics - instrumentation; Single port; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - instrumentation; Time Factors; Treatment Outcome; Urology; Ohio; Radical nephrectomy; Single port; LESS; Robotic; Kidney cancer
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2011.02.020

Abstract Background Recent reports have suggested that robotic laparoendoscopic single-site surgery (R-LESS) is feasible, yet comparative studies to conventional laparoscopy are lacking. Objective To report our early experience with R-LESS radical nephrectomy (RN). Design, setting, and participants A retrospective review of R-LESS RN data was performed between May 2008 and November 2010. A total of 10 procedures were performed and subsequently matched to 10 conventional laparoscopic RN procedures (controls). The control group was matched with respect to patient age, body mass index (BMI), American Society of Anesthesiologists score, surgical indication, and tumor size. Surgical procedure R-LESS RN was performed using methods outlined in the manuscript and supplemental video material . All patients underwent R-LESS RN by a single surgeon. Single-port access was achieved via two commercially available multichannel ports, and robotic trocars were inserted either through separate fascial stabs or through the port, depending on the type used. The da Vinci S and da Vinci-Si Surgical Systems (Intuitive Surgical, Sunnyvale, CA, USA) with pediatric and standard instruments were used. Measurements Preoperative, perioperative, pathologic, and functional outcomes data were analyzed. Results and limitations The mean patient age was 64.0 yr of age for both groups, and BMI was 29.2 kg/m2 . There was no difference between R-LESS and conventional laparoscopy cases in median operative time, estimated blood loss, visual analogue scale, or complication rate. The R-LESS group had a lower median narcotic requirement during hospital admission (25.3 morphine equivalents vs 37.5 morphine equivalents; p = 0.049) and a shorter length of stay (2.5 d vs 3.0 d; p = 0.03). Study limitations include the small sample size, short follow-up period, and all the inherent biases introduced by a retrospective study design. Conclusions R-LESS RN offers comparable perioperative outcomes to conventional laparoscopic RN. Prospective comparison is needed to definitively establish the position of R-LESS in minimally invasive urologic surgery.