| Background The rapid advancement in medical technology,the expectation of patients with "minimally invasive" surgeries,and the aesthetic and urgent requirements for incision healing,these factors together make clinical surgeons and related researchers continue to delve into research,update treatment concepts,chase more safe,efficient,minimally invasive,beautiful surgery.From the "dagger" open surgery to the "pinhole relative" minimally invasive laparoscopic surgery,fully demonstrated the technological changes and the concept of innovation.Surgeons have reached the ultimate in the pursuit of perfect surgery,"scarless" surgery.Based on the traditional laparoscope surgery,can we further reduce the puncture channel to achieve the same surgical results? Can you achieve near-scarred surgery? In this context,laparoendoscopic single-site surgery(LESS)surgery came into being.LESS surgery was first applied to urological surgery in 2007.Since then,scholars have successively reported a single-site laparoscopic partial nephrectomy,radical nephrectomy,and pyeloplasty.The safety and cosmetic effects of LESS surgery have been recognized by everyone,but at the same time some scholars have proposed the limitations of the technology: 1.Contrary to the traditional "triangular distribution" principle of laparoscopic sleeve;2.Conventional single-site laparoscope has only one incision,all instruments must all pass through this channel,resulting in inevitable "fight" phenomenon between instruments during operation;3.Compared with conventional laparoscopic surgery,LESS is more difficult,and the operation takes more time.This subject is intended to study and design the above problems.By adding one additional channel to the conventional LESS,the adverse effects caused by the “collision” between the surgical instrument and the lens body will be reduced,and additional channels may be used for postoperative drainage.And does not affect the overall postoperative cosmetic results.Based on this study,we conducted a retroperitoneal laparoendoscopic single-site plus one port surgery versus traditional retroperitoneal laparoendoscopic sugery in the treatment of renal cell carcinoma.Objective To investigate the safety,efficacy and surgical efficacy of retroperitoneal laparoendoscopic single-site plus one port(Less-pop)versus standard retroperitoneal laparoendoscopic surgery in the treatment of renal cell carcinoma.Subjects and methods The clinical data of patients with renal cell carcinoma admitted to our hospital from January 2015 to January 2016 were collected.According to the principle of random distribution,60 patients were divided into two groups.30 patients were retroperitoneal laparoendoscopic single-site plus one port group,19 males and 11 females.Age from 49 to 65 years old,average 53.7±4.3 years old;Body mass index 17.9~28.4,average 23.6±3.3kg/m2;tumor located in left side 18 cases,right side in 12 cases;tumor in 3 cases of suprarenal pole,8 cases of renal middle pole,infrarenal pole 19 cases;tumor diameter 2.0~6.5cm,average 5.4±1.5cm;30 cases of standard laparoscopic group,17 males and 13 females;aged 50~71 years old,average 57.5±3.9 years old;body mass index 18.1~26.9,average 24.2±2.8kg/m2;tumors located in 17 cases on the left side and 13 cases on the right side;tumors located in 4 cases in the upper pole of the kidney,6 cases in the middle of the kidney,20 cases in the lower pole of the kidney.The tumor diameter was 2.3~5.9cm with an average of 5.9±1.3cm.There was no significant difference in gender,age,body mass index BMI,tumor diameter,tumor location between the two groups(P>0.05).The data of intraoperative blood loss,operation time,drainage tube indwelling time,postoperative hospital stay,peritoneal breaking rate and postoperative incision satisfaction were analyzed.Results All 60 cases were successfully treated with radical resection of renal cell carcinoma.No other conversion was performed.LESS-POP group and standard retroperitoneal group: tumor diameter(5.4±1.5 vs 5.9±1.3)cm,intraoperative blood loss(17.0±4.0 vs 20±5.0)ml,operation time(111.0±17.0 vs 100.0±17.0)min,postoperative drainage catheter indwelling time(3.5±0.5 vs 4.4±1.4)d,postoperative hospital stay(6.85±0.97 vs 7.13±1.12)d,incision satisfaction(3.83±1.18 vs 2.96±1.23).There was no significant difference in gender,age,BMI,tumor diameter,intraoperative blood loss,operative time and peritoneal breaking rate between the two groups.There was a statistically significant difference in the number of days hospitalized,drainage tube indwelling time,and incision satisfaction.Conclusion LESS-POP treatment of renal tumor disease is safe and effective.Compared with standard retroperitoneoscopic surgery,it has the advantages of less trauma,shorter drainage tube placement,and higher patient satisfaction with incision. |
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