| Background and Objective With the development of technology and medicine,laparoscopy is widely used in urology.Because of its obvious advantage of minimal invasion,many previous open surgeries have been replaced by laparoscopic surgeries.In recent years,with the improvement of concept of minimal invasion and the development of patient's awareness of beauty,how to further reduce trauma and improve cosmetic effect based on the traditional laparoscopy has become a new topic of many scholars,therefore,laparoendoscopic single-site surgery(LESS)came into being.With the development of clinical studies,LESS has been disputed constantly,some scholars pointed out that LESS has less invasion than traditional laparoscopy,and it has obvious advantages and broad application prospect.While other scholars pointed out that LESS should be choosed carefully due to its inconvenivent operation and more difficulties.Based on this situation,we carried out the comparative clinical study of retroperitoneal laparoscopic single-site surgery and conventional retroperitoneal laparoscopic surgery in treatment of renal cysts.The purpose is to explore the safety and effectiveness of retroperitoneal laparoscopic single-site surgery compared with conventional retroperitoneal laparoscopic surgery in treatment of renal cysts.and then preliminarily discuss on the application prospect of LESS in urology.Methods 81 cases with simple renal cysts who underwent surgery treatment from October 2012 to May 2015 were retrospectively analyzed.The patients are divided into two groups,36 cases treated by retroperitoneal laparoscopic single-site surgery by using the homemade single-site platform(experimental group),the others treated by conventional retroperitoneal laparoscopic surgery(control group).The two groups have no statistic discrepancy in gender,age,body mass index(BMI),the diameter of cysts and the cysts location(P> 0.05).The operation time,blood loss,postoperative fasting time,postoperative pain score,postoperative drainage tube indwelling time,postoperative hospital stay,incidence of wound infection,satisfaction score of incision and the cyst recurrence rate in two groups were analyzed statistically.Results The surgery in all cases were successfully according to plan,no intraoperative change of surgery approach or temporary conversion to open surgery,no serious bleeding,no pleural and abdominal organ injury,no acidosis and no cases with significant postoperative fever.The two groups of blood loss(23.11 ± 6.53 ml vs 23.69 ±5.15 ml P> 0.05),the incidence of peritoneum damage(2/36 vs 1/45 P> 0.05),postoperative fasting time(18.08 ± 4.78 h vs 17.36 ± 4.26 h P> 0.05),postoperative drainage tube indwelling time(30.56 ± 10.33 h vs 30.89 ± 11.67 h P> 0.05)and the incidence of wound infection(1/36 vs 2/45 P> 0.05)have no significant statistical differences.Conversely,statistical differences were found between the two groups in terms of the incidence of subcutaneous emphysema(2/36 vs 13/45 P <0.05),postoperative pain scores(2.31 ± 0.98 vs 3.00 ± 1.11 P <0.05),postoperative analgesic demand rate(3/36 vs 12/45 P <0.05),postoperative hospital stay(4.86 ± 0.96 d vs 5.67 ±1.33 d P <0.05)and satisfaction score of incision(3.78 ± 1.27 vs 2.93 ± 1.21 d P <0.05),Compared with control group,experimental group has obvious advantages in these four indicators.Experimental group has disadvantage in terms of operation time(60.22 ±15.05 min vs 41.16 ± 5.58 min P <0.05).All the patients were followed up from six months to 3 years after leaving hospital,and cyst recurrence was not found by reviewing the B ultrasound or CT.Conclusions LESS is the further development on the basis of traditional laparoscopy,retroperitoneal laparoscopic single-site surgery is simple and effective for the treatment of renal cyst,especially for the patient with renal cyst located in the middle and lower pole of kidney.LESS has advantages in terms of reducing the incidence of subcutaneous emphysema,less postoperative pain,shorter hospital stay and improving incision satisfaction score,there were no significant difference in terms of efficacy and complications,LESS required longer operation time.With proper screening of cases and the ability of skilled traditional laparoscopic surgery,LESS is a safe and feasible,effective and reliable minimally invasive method,particularly suitable for patients with cosmetic requirements.Homemade single-site multi-channel device is inexpensive and easy to made,the device is worthy of promotion and application in clinical. |
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