Abstract: PD73-10
Sources of Funding: none

Introduction

Laparoendoscopic single site nephrectomy (LESS-N) has been shown to offer better cosmetic outcomes on the expense of longer operative times compared to laparoscopic nephrectomy (LN). It was also associated with debatable improvement in blood loss, pain scores, hospital stay and postoperative recovery. The aim of this study is to present an operative and postoperative outcome comparison between LN and LESS-N in all patients with different nephrectomy indications.

Methods

This single blinded prospective randomized control trial was conducted at the Urology department of Cairo University from 2012 to 2014. 54 Patients indicated for nephrectomy were randomized to either LESS-N or LN. The main outcomes analyzed included operative time, blood loss, hospital stay, complications and visual analogue pain scores. We used the days off work and the days needed to reach 100% of previous physical activity as clinical end points to compare convalescence. We also compared body image satisfaction scores and the overall rating of the experience.

Results

The mean age at nephrectomy was 35 years in the LESS-N group and 40 in the LN group (p=0.2). Indications for nephrectomy were recurrent urinary tract infections in nonfunctioning kidneys (n=36), malignant renal masses (n= 10), Donor nephrectomy (n=6) and renovascular hypertension (n=2). Compared to LN the mean operative time was longer in the LESS group (157 vs 182 min, p=0.046). There was no statistically significant difference in the mean blood loss (115 vs 148 ml, p=0.331), hospital stay (2.9 vs 3.2 days, p=0.14) or pain scores. Four patients (14.8%) from the LESS-N group suffered from complications compared to only 1 patient (3.7%) from the LN group. The patient’s mean scar satisfaction score was higher in the LESS group (9.3 vs 8.3, p=0.003). The mean days off work (20.7 vs 27.3 days, p=0.07), the mean number of days to 100% activity (53.7 vs 70.6, p=0.14) and the score given to the overall experience by the patient (8.8 vs 8.4, p=0.3) did not differ significantly between the 2 groups

Conclusions

LESS-N offers a superior cosmetic outcome compared to LN on the expense of operative time and surgical difficulty. However, the LN group also enjoyed excellent scar satisfaction. Many studies showed that the importance of cosmesis is more evident in younger patients and those with non-oncological conditions. We believe that the choice for LESS nephrectomy should be tailored to each specific patient according to his age, individual perception of scar importance, indication for nephrectomy and size of kidney to be removed rather than offering it unanimously to all our nephrectomy population

Funding

none