The Alternative to Laparoendoscopic Single-Site Surgery: Small Strategic Laparoscopic Incision Placement (SLIP) Nephrectomy Improves Cosmesis Without Technical Restrictions

摘要

Background: The latest attempt to improve the cosmesis of laparoscopic surgery is laparoendoscopic single-site surgery (LESS). We present our initial experience with an alternative procedure with similar cosmetic benefit but without technical limitations. Methods: Small strategic laparoscopic incision placement (SLIP) nephrectomy is performed transperitoneally, generally using three 5-mm ports (one in the umbilicus) and one 12-mm port placed below the pubic hairline, such that only two 5-mm scars are visible without close inspection. We assessed our first 21 procedures, which included all but five of the standard transperitoneal nephrectomies by a single surgeon from June 2008 through July 2009. These were matched 1:2 (exactly by gender and American Society of Anesthesiology score, and then closest in age and body mass index) from 96 patients undergoing similar standard transperitoneal laparoscopic procedures from 2005 through 2008. Results: The SLIP and control groups were well matched, with mean age and body mass index differing by only 3.6 years and 1.1, respectively. Of the SLIP patients, 34% were obese or morbidly obese, and a trainee was the primary surgeon in 81% of cases. Mean operative time was 23 minutes longer in the SLIP cases. There was no difference between groups in estimated blood loss, complication rate, or convalescence. Conclusions: Like LESS, SLIP nephrectomy provides improved cosmesis. Unlike LESS, it is only slightly more difficult to perform than standard laparoscopic nephrectomy and can be performed in technically challenging cases (obesity, large specimen, etc). Similar to the literature on LESS, there is no convalescence benefit to SLIP nephrectomy; the advantage over standard laparoscopy is purely cosmetic.