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Laparoendoscopic single-site (LESS) robot-assisted partial nephrectomy (RAPN) reduces postoperative wound pain without a rise in complication rates

Authors
 Tae Young Shin  ;  Sey Kiat Lim  ;  Christos Komninos  ;  Dong Wook Kim  ;  Woong Kyu Han  ;  Sung Jun Hong  ;  Byung Ha Jung  ;  Koon Ho Rha 
Citation
 BJU INTERNATIONAL, Vol.114(4) : 555-562, 2014 
Journal Title
 BJU INTERNATIONAL 
ISSN
 1464-4096 
Issue Date
2014
MeSH
Aged ; Carcinoma/pathology ; Carcinoma/surgery* ; Female ; Humans ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery* ; Laparoscopy* ; Length of Stay ; Male ; Middle Aged ; Nephrectomy/adverse effects ; Nephrectomy/methods* ; Operative Time ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control* ; Retrospective Studies ; Robotics* ; Treatment Outcome ; Warm Ischemia
Keywords
laparoendoscopic single-site (LESS) ; partial nephrectomy ; postoperative pain ; robotics
Abstract
OBJECTIVE: To compare long-term functional outcomes and pain scale scores of patients who underwent laparoendoscopic single-site (LESS)- robot-assisted partial nephrectomy (RAPN) to those who underwent conventional RAPN (C-RAPN), as LESS surgery is increasingly being adopted by urologists worldwide to reduce morbidities and scarring associated with surgical interventions. PATIENTS AND METHODS: In all, 167 consecutive patients who had RAPN were identified from our Institutional Review Board-approved computerised database between October 2006 to July 2012. Patients were stratified into two groups: 80 patients who underwent C-RAPN and 79 who underwent LESS-RAPN. RESULTS: The LESS-RAPN group had a longer warm ischaemia time [WIT, mean (sd) 26.5 (10.5) vs 19.8 (13.1) min; P = 0.001] and total operation time [TOT, mean (sd) 210.3 (83.4) vs 183.1 (76.1) min; P = 0.033] when compared with the C-RAPN group. While, the LESS-RAPN group and C-RAPN group were not significantly different for the number of patients with negative surgical margins [77 (96.2%) vs 73 (91.4%); P = 0.194), absolute change in postoperative renal function [mean (sd) -6.5 (16.7)% vs -7.6 (16.7)%; P = 0.738) and postoperative complications rate [12 (15.0%) vs 10 (12.6%); P = 0.279). Furthermore, the LESS-RAPN group had lower visual analogue pain scale (VAPS) scores at discharge [mean (sd) 2.1 (1.3) vs 1.7 (1.0); P = 0.048]. CONCLUSIONS: Despite a significantly longer WIT and TOT, the functional outcomes of LESS-RAPN were comparable to those of C-RAPN for tumours of similar mean sizes and complexities, without any detriments in oncological and complications outcomes. On discharge, patients who underwent LESS-RAPN also reported lower pain levels as one of the advantages of minimally invasive surgery. With the development of instrumentation specifically designed for single-site surgery, LESS could be more easily conducted in patients who are interested in improved quality of life outcomes.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/bju.12783/abstract
DOI
10.1111/bju.12783
Appears in Collections:
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Wook(김동욱)
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Shin, Tae Young(신태영)
Lim, Sey Kiat(임세이캣)
Chung, Byung Ha(정병하) ORCID logo https://orcid.org/0000-0001-9817-3660
Komninos, Christos(크리스토스콤니노스)
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
Hong, Sung Joon(홍성준) ORCID logo https://orcid.org/0000-0001-9869-065X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100117
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