1082 PROSPECTIVE RANDOMIZED COMPARISON BETWEEN NEEDLESCOPIC-ASSISTED AND LESS NEPHRECTOMY IN THE PORCINE MODEL

Abstract

INTRODUCTION AND OBJECTIVES: Laparoendoscopic single-site surgery (LESS) produces virtually no scar but is technically challenging due to the loss of triangulation. There have been no prospective studies comparing LESS to other forms of minimally invasive surgery. The purpose of this study was to compare LESS with needlescopic-assisted laparoscopy (NAL) in the setting of laparoscopic nephrectomy in the porcine model. METHODS: Ten female farm pigs were randomized to laparoscopic nephrectomy with LESS or NAL. In NAL, 5 and 10 mm ports were placed in the umbilicus and a 2 mm port was placed in the midclavicular line. With LESS a Triport was placed through a single 2.5 cm umbilical incision. Preoperative, perioperative, and postoperative parameters were compared. The Likert scale (1-10) was used to rate surgeon comfort and technical difficulty. Objective cosmesis was measured by a blinded cosmetic dermatologist using the modified Vancouver Scar Scale (VSS). Subjective cosmesis was assesed for the best overall appearance. Both subjective and objective cosmesis were then compared with a paired t-test and a cost analysis was performed. RESULTS: There was no difference in complications, blood loss, objective (p=0.75) or subjective cosmesis (p = 0.48). In the NAL group, operative time was shorter (103 vs. 150 minutes, p=0.008) and both surgeon comfort (7.78 vs. 2, p=0.003) and ease (7.8 vs. 2 p=0.002) was significantly better. NAL had significantly lower disposable cost ($1195 vs. $228, p = <0.01). CONCLUSIONS: NAL is safe and effective, enabling shorter operative times, increased surgeon comfort, technical ease and lower cost, while maintaining the scarless outcome of LESS.