Laparoendoscopic Single-Site Varicocelectomy Significantly Superior to Conventional Lap Approach

By John Henry Dreyfuss, MDalert.com contributor.

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  • Laparoendoscopic single-site varicocelectomy found to be superior surgical approach for resolution of varicocele.
  • Cochrane meta-analysis included 6 trials
  • Laparoendoscopic single-site varicocelectomy was superior to conventional laparoscopic surgery with respect to postoperative pain scores, time to convalescence, cosmetic satisfaction, and other clinical variables.
  • Operative time was shorter with CTL-V versus LESS-V.
  • There were no differences between LESS-V and CTL-V in hospital stay and postoperative complications.

Laparoendoscopic single-site varicocelectomy (LESS-V) appears to be the superior surgical approach for treatment of varicocele (Figures 1 and 2). LESS-V is associated with significant improvement in a number of clinical areas compared with conventional laparoscopic surgery (CTR-V; Figure 3). These are among the results of a systematic review and meta-analysis published recently in SpringerPlus.

This meta-analysis found that LESS-V was safe and that it resulted in significantly reduced postoperative pain, shorter recovery time, and better cosmetic outcome, compared with CTR-V. CTR-V, however, resulted in shorter operative times compared with CTR-V.

Figure 1. Varicocele.
(Sources: Wikipedia/By BruceBlaus - Own work/Creative Commons.)

Laparoendoscopic single-site (LESS) surgery has been developed in an attempt to further reduce the morbidity and scarring associated with surgical intervention, the authors explained. According to the results of this analysis, many of the clinical objectives of using the LESS approach seem to have been realized. For instance, pooled data showed significant lower Visual Analogue Scale (VAS) pain scores in the LESS-V group compared with the CTL-V group.

The pooled data also significantly favored the LESS-V approach with regard length of hospital stay, time required for patients to return to normal activity, rates of postoperative complications, improvement of semen parameters, and patient satisfaction with cosmetic results.

Importantly, this meta-analysis also demonstrated that the LESS-V approach is as safe as the more conventional CTR-V approach.

 

Figure 2. Varicocele and testis in ultrasound (transverse image).
(Sources: Wikimedia Commons/By Schomynv - Own work/Creative Commons.)

The Analysis

In conducting the review, the researchers queried The Cochrane Library; the MEDLINE, EMBASE, Science Citation Index Expanded; and Google Scholar databases. The reviewers examined Literature review included meta-analyses, and randomized and nonrandomized prospective studies. They used weight mean difference (WMD) to measure hospital stay, time to return normal activity, postoperative pain and improvement of semen parameters and odds ratio (OR) to postoperative complications and cosmetic satisfaction.

The reviewers identified 6 studies that met eligibility criteria. The meta-analysis revealed that LESS-V was superior to CTL-V with respect to:

  • Postoperative pain scores (WMD: -0.46; 95 % confidence interval [CI] -0.75 to -0.17; P=0.002);
  • Time to convalescence (WMD: -1.4 days; 95 % CI -2.55 to -0.25; P = 0.02);
  • Patient satisfaction with cosmetic appearance (OR 6.86; 95 % CI 2.89-16.28; P<0.00001).

In contrast, the reviewers found that CTL-V was superior to LESS-V with respect to operative times (WMD 1.96 min, 95 % CI 0.96-2.96; P=0.0001).

The authors detected no differences between LESS-V and CTL-V in terms of hospital stay (WMD: -0.02 days, 95 % CI -0.39 to 0.35; P=0.92) or postoperative complications (OR 1.13, 95 % CI 0.57-2.21; P=0.73).

 

 

Figure 3. Conventional laparoscopic varicocelectomy.
(Sources: Wikipedia/By Kirk - Own work/Creative Commons.)

Conclusions

“Our meta-analysis of 3 RCTs and 3 retrospective studies including 460 patients comparing the efficacy of LESS-V and CTL-V showed that LESS-V was safe, with significantly reduced postoperative pain, shorter recovery time, and better cosmetic outcome,” the authors concluded. “We found no significant differences in postoperative complications, hospital stay and improvement of sperm parameters.”


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