Login to Access Video or Poster Abstract: MP52-06
Sources of Funding: none

Introduction

The key advantages of LESS are better cosmesis and less morbidity. Meanwhile, instrument clashing and loss of triangulation are the main limitations. ML overcomes such limitations but with multiple mini-incisions. The two approaches were compared.

Methods

A prospective randomized trial was conducted to compare the LESS versus ML nephrectomy. LESS nephrectomy was performed via a skin incision at the umbilicus. Three ports (5mm each) were placed through this incision. Meanwhile, ML nephrectomy was done through 3 ports (3-5 mm each) where the camera port was placed at the umbilicus.The cosmetic outcome (primary end point), operative time, blood loss, hospital stay and complications were recorded and compared. Patient scar assessment questionnaire (PSAQ) was used for evaluation of cosmetic outcome and patient satisfaction with the scars at 3 month postoperatively. The PSAQ consists of 5 sub-scales: appearance, symptoms, consciousness, satisfaction with appearance and satisfaction with symptoms. Each sub-scales consists of a set of items with 4 point categorical responses, scoring 1-4 points with 1 point assigned to the most favorable category and 4 assigned to the least favorable. Experienced laparoscopic surgeons performed all procedures. The estimate sample size was 62 patients. The cases were randomized using a computer generated numbers.

Results

Thirty-one patients were included in each arm. Preoperative data were comparable in both groups. The cosmetic outcome had no statistical difference in the two groups (Table:1). The operative time was significantly longer in LESS group (119 ± 23 versus 73 ± 14 min, p <0.001). The estimated blood loss was less in ML patients (55 ± 18 versus 102 ± 27 ml in LESS group, p <0.001). Extra port was needed in 3 and 4 patients in LESS and ML groups respectively (p>0.05). Conversion to conventional laparoscopy was recorded in one of LESS cases. Conversion to open surgery was reported in one patient in each group (p>0.05). The complication rates and grades were comparable in both groups. Hospital stay was 2.1 and 1.8 days for LESS and ML groups (p>0.05).

Conclusions

ML represents a real alternative to LESS with comparable cosmetic outcome, shorter operative time and less blood loss.

Funding

none