purpose: This study was to introduce the modified mini-laparoscopic surgery for renal cyst and investigate its advantages on operative time, cosmetic effect and pain reduction by comparison with laparo-endoscopic single site surgery (LESS) and conventional laparoscopic surgery.
Methods and patients: Between May 2015 and October 2018, 140 consecutive patients with benign renal cyst underwent laparoscopic decortication of renal cyst. Of which, 48 cases were in mini-laparoscopic surgery group (M group), 56 cases in LESS group and 36 cases in conventional laparoscopic surgery group (C group). The operative time, blood loss, visual analog scale (VAS) and Scar Cosmesis Assessment and Rating (SCAR) Scale was recorded.
Results: The mean operative time in M group (26.08±7.70 min) and C group (28.56±7.99 min). was significantly less than that in LESS group (47.32 ±10.53 min) (P<0.01). Mean blood loss did not differ between the 3 groups (P>0.05). Mean VAS pain scores in M group were significantly lower than that of LESS group and C group on postoperative day (POD) 1 and 3 (P<0.01). The SCAR scale of POD 30 in C group (6.25±1.0) was significantly higher than that in M group (0.77±0.59) and LESS group (0.98±0.70). The postoperative course was uneventful with no morbidity within 1to 6 months of follow-up.
Conclusion: Modified mini-laparoscopic decortication of renal cyst have more comprehensive advantages comparing with LESS and conventional laparoscopic surgery. It is convenient and offered significant cosmetic benefit and reduced incisional pain.
Rané A. Laparoscopic management of symptomatic simple renal cysts. Int Urol Nephrol. 2004;36:5–9.
Bas O, Nalbant I, Can Sener N, et al. Management of renal cysts. JSLS. 2015;19 :e2014.00097.
Carus T. Current advances in single-port laparoscopic surgery. Langenbecks Arch Surg 2013; 398: 925-929
Goel R, Lomanto D. Controversies in single-port laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 2012; 22: 380-382
Kim SJ, Ryu GO, Choi BJ, et al. The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg 2011; 254: 933-940
Weiss HG1, Brunner W, Biebl MO, et al. Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures. Ann Surg 2014; 259: 89-95
Ahmed K, Wang TT, Patel VM, et al. The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc 2011; 25: 378-396
Asakuma M, Hayashi M, Komeda K, et al. Impact of single-port cholecystectomy on postoperative pain. Br J Surg 2011; 98: 991-995
Kantor J. The SCAR (Scar Cosmesis Assessment and Rating) scale: development and validation of a new outcome measure for postoperative scar assessment. Br J Dermatol. 2016 Dec;175:1394-1396
Kantor J. Reliability and Photographic Equivalency of the Scar Cosmesis Assessment and Rating (SCAR) Scale, an Outcome Measure for Postoperative Scars.JAMA Dermatol. 2017 Jan 1;153:55-60.
Miyajima A1, Hattori S, Maeda T, et al. Transumbilical approach for laparo-endoscopic single-site adrenalectomy: initial expe- rience and short-term outcome. Int J Urol. 2012;19: 331-5.
Inoue S, Ikeda K, Kajiwara M, et al. Laparoendoscopic single-site adrenalectomy sans transumbilical approach: initial experience in Japan. Urol J. 2014;11:1772-6
Carvalho GL, Loureiro MP, Bonin EA, et al. Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches.JSLS. 2012;16:569-75.
Abdel-Karim AM, El Tayeb MM, Yahia E, et al. Evaluation of the Role of Laparoendoscopic Single-Site Surgery vs Minilaparoscopy for Treatment of Upper Urinary Tract Pathologies: Prospective Randomized Comparative Study. J Endourol. 2017;31:1237-1242.
Soble JJ, Gill IS. Needlescopic urology: incorporating 2-mm instruments in laparoscopic surgery. Urology. 1998;52(2):187-94.
Gill IS. Needlescopic urology: current status. Urol Clin North Am. 2001;28(1):71-83.