Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence.

BACKGROUND: Recent reports have suggested that single-port or single-incision laparoscopic surgery (SILS) is technically feasible.

OBJECTIVE: To present a comparison between SILS and conventional laparoscopic nephrectomy with respect to perioperative outcomes and short-term measures of convalescence.

DESIGN, SETTING, AND PARTICIPANTS: This was a case-control study comparing 11 SILS nephrectomies (cases) and 22 conventional laparoscopic nephrectomies (controls) performed from September 2004 to April 2008. The control group was matched in a 2:1 ratio to SILS cases with respect to patient age, surgical indication, and tumor size.

INTERVENTION: A single surgeon performed all SILS nephrectomy cases using three adjacent 5-mm trocars inserted through a single 2.5-cm periumbilical incision.

MEASUREMENTS: Demographics, operative time, blood loss, perioperative complications, transfusion requirement, decrease in serum hemoglobin, analgesic requirement, length of stay, and final pathology were compared.

RESULTS AND LIMITATIONS: Mean patient age was 53 yr for both groups, with more females in the SILS cohort (82% vs 41%). Nephrectomy was performed for benign disease in 45% of the cases. Median tumor size was 5.5 cm for both groups, and all but one suspected malignancy was renal cell carcinoma on final pathology. There was no difference between SILS and conventional laparoscopy cases in median operative time (122 min vs 125 min, p=0.78), percent decrease from preoperative hemoglobin (14.1% vs 15.8%, p=0.52), analgesic use (8 morphine equivalents vs 15 morphine equivalents, p=0.69), length of stay (49 h vs. 53 h, p=0.44), or complication rate (0% for both). The SILS group did have a lower recorded median estimated blood loss (20 ml vs 100ml, p=0.001). This study is retrospective and is susceptible to all limitations and biases inherent in such a design.

CONCLUSIONS: SILS nephrectomy is feasible with perioperative outcomes and short-term measures of convalescence comparable to conventional laparoscopic nephrectomy. Although SILS may offer a subjective cosmetic advantage, prospective comparison is needed to more clearly define its role.