Comparative study for evaluating the cosmetic outcome of small-incision access retroperitoneoscopic Technique (SMART) with standard retroperitoneoscopy using Observer Scar Assessment Scale (OSAS). Are small incisions a big deal? - Abstract

Aim: To compare the scars and cosmetic results of trocars of 3-mm, 5-mm, and 10-mm in cases by small-incision access retroperitoneoscopic technique pyeloplasty (SMARTp) and standard laparoscopy pyeloplasty (SLp).

Methods: Between January 2012 and October 2013, 20 pyeloplasties were performed 12 with SMARTp and 8 with SLp techniques. A 5-mm homemade balloon trocar was used to create the retroperitoneal space. In SMARTp, 3- and 5-mm trocars were used and in SLp, 5- and 10-mm trocars were used. All patients underwent a ureteral (Double-J) stent placement preoperatively. The study included a total of 72 trocar-site scars; 3-mm (24 scars), 5-mm (24 scars) and 10-mm (24 scars). Cosmetic outcome was assessed at the 3rd, 12th and 24th month of surgeries by the Observer Scar Assessment Scale (OSAS).

Results: Mean age was 34.7±10.5 (19-52) years and mean follow-up was 18.7±9.2 months. Fifteen patients (75%) underwent Y-V plasty and 5(25%) Anderson-Hynes pyeloplasty. Mean operative time was 125.4±28.7 minutes. There was only minimal blood loss, no need for conversion to standard laparoscopic or open pyeloplasty, no intraoperative complications and only 2 postoperative complications were recorded: retroperitoneal hemorrhage and wound infection and both were treated conservatively. There were significant differences between objective questions of ''vascularization'' in 3-mm trocar, and ''thickness'' in 10-mm trocar. 24 months after surgery, the cosmetic data assessed by OSAS showed statistically significant in favor of the 3-mm trocar sites versus 10-mm (OSAS: 13.8±3.9 vs. 24.6±1.7; P = 0.006) with no statistical significant difference between 3-mm and 5-mm port sites.

Conclusions: The SMARTp is proved as an efficacious and tolerable procedure with better cosmetic results and can be used for the treatment of ureteropelvic junction obstruction (UPJO) in suited patients. We believe that this technique is likely to become an established procedure.

Written by:
Al Nasser M, Pini G, Gözen AS, Elashry OM, Akin Y, Klein J, Almouhissen T, Rassweiler J.   Are you the author?
Klinikum Heilbronn, Deparment of urology, Heilbronn, Germany.  

Reference: J Endourol. 2014 Aug 4. Epub ahead of print.
doi: 10.1089/end.2014-0142.ECC14

PubMed Abstract
PMID: 25091114 Endourology Section