"LESS" painful form of laparoscopy proven in kidney cancer

An emerging, minimally invasive surgical technique called laparoendoscopic single-site surgery (LESS) was associated with a less painful recovery than was traditional multiport laparoscopy among persons undergoing complete or partial removal of the kidney due to cancer.

In a nonrandomized, prospective study, 34 patients underwent LESS (17 for radical nephrectomy and 17 for partial nephrectomy), and 42 underwent multiport laparoscopy (28 for radical nephrectomy and 14 for partial nephrectomy) from February 2009 to February 2010. LESS was performed with one small incision in the umbilicus, through which all tools were inserted to reach the renal tumor. The traditional laparoscopy used four to six incisions.

The mean follow-up period was 16.2 months. Mean operating time was 159.3 minutes for LESS and 158.9 minutes for multiport laparoscopy; mean estimated blood loss was 175.7 mL and 156.1 mL, respectively. No significant differences in complications were noted. However, for patients undergoing radical nephrectomy, a significant decrease in analgesic use was seen in the LESS group compared with the traditional-laparoscopy group, at 6 morphine equivalents vs 11.6 morphine equivalents. Discharge pain score was also lower after radical nephrectomy with LESS (1.7 vs 2.7 for multiport laparoscopic radical nephrectomy).

“We found that patients rated the LESS surgery as 40% less painful than traditional laparoscopic surgery while requiring approximately 50% less narcotic pain medication,” summarized urologic oncologist and study senior author Ithaar Derweesh, MD, of the University of California–San Diego (UC San Diego) Moores Cancer Center, in a statement issued by UC San Diego. “This is an excellent sign that the LESS technique may further improve the quality of life of appropriate patients undergoing major cancer surgery.”

Nevertheless, wrote Derweesh and colleagues in Urology, randomized evaluation and longer-term follow-up are necessary to ascertain whether LESS is indeed comparable to multiport laparoscopic surgery and does confer a benefit with respect to analgesic requirement.

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