Does LESS Produce Better Outcomes Than Conventional Laparoscopy?

There is little difference in the effectiveness and safety of laparoendoscopic single-site surgery (LESS) and conventional laparoscopic surgery (CL) for the treatment of gynecological diseases, concluded the findings of a recently published meta-analysis conducted in Korea.¹ In addition, the analysis found that LESS offers no advantages over CL in terms of cosmesis and postoperative pain despite anecdotal observations that LESS is associated with improved cosmetic results and reduced postoperative pain.¹
   
This meta-analysis included 6 randomized controlled trials that involved a total of 439 participants. The analysis showed no significant differences between LESS and CL for many factors for which LESS has been considered advantageous. When comparing LESS with CL, the perioperative complication rates were 15.5% and 14.3%, respectively, and the rates of needing to convert to abdominal surgery were 3.8% and 1.1%, respectively. Although postoperative pain was slightly less in the LESS group compared with the CL, the difference did not reach statistical significance group (weighted mean difference, -0.22).
   
Analgesic requirements and satisfaction with the cosmetic result were also similar between study groups, although the analgesic requirements were slightly greater for patients in the LESS group (weighted mean difference, 0.41; P=0.70), as was overall cosmetic satisfaction (weighted mean difference, 0.19; P=0.46). Operative time, changes in hemoglobin, time to first flatus, and length of hospital stay also were similar between surgical techniques.
   
Early reports from general surgery and urology showed that LESS, compared with CL, resulted in improved cosmesis, a shorter period of convalescence, and decreased postoperative analgesia requirements.² Since 2008, LESS has become increasingly utilized for the treatment of gynecological conditions, and the general consensus supports that LESS technology offers improved cosmesis because of the single port of entry. However, the available evidence to date has not definitively verified this benefit.
   
According to the investigators, this meta-analysis provides evidence that the effectiveness and safety of LESS is comparable to that of CL but that LESS offers no additional advantages over CL. The potential benefits of LESS remain, however. As surgeons become more experienced with the technology and as larger studies evaluating LESS are conducted, this conclusion may change, asserted the authors.

Pertinent Points:
- The effectiveness and safety of laparoendoscopic single-site surgery (LESS) is comparable to that for conventional laparoscopic surgery.
- For gynecological disease, LESS does not offer additional benefits, such as improved cosmesis and less pain.
 

References:

1. Song T, Kim ML, Jung YW, et al. Laparoendoscopic single-site versus conventional laparoscopic gynecologic surgery: a meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2013 Jul 13. DOI: 10.1016/j.ajog.2013.07.004. [Epub ahead of print]
2. Fader AN, Levinson KL, Gunderson CC, et al. Laparoendoscopic single-site surgery in gynaecology: a new frontier in minimally invasive surgery. J Minim Access Surg. 2011;7:71-77.