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[36] matched a total of 11 patients undergoing LESS laparoscopic simple nephrectomy with a group of 10 patients who previously underwent simple nephrectomies. Two LESS simple nephrectomy procedures required placement of an additional instrument. No significant difference was noted between the two groups in terms of operative time, blood loss, hospital stay and narcotic analgesia requirement. Jeong et?al. [37] compared nine patients undergoing LESS vs 17 patients undergoing standard laparoscopic adrenalectomy. Controls were matched for age, sex, surgical indications and tumour size. One patient in each group underwent conversion to standard laparoscopic and open surgery respectively. No significant differences in the mean operative time, blood loss and postoperative hospital stay were observed between the groups. Postoperative pain, as measured by the number of days http://www.selleckchem.com/products/MK-1775.html of intravenous patient-controlled anaesthesia use, was significantly lower in the LESS group (0.9 vs 1.9 days, P? http://www.selleckchem.com/products/AZD6244.html et?al. [38] performed a retrospective cohort study to compare the efficacy and safety of LESS vs laparoscopic vs robotic sacrocolpopexy. At 6-months follow-up the LESS procedure appeared comparable to the laparoscopic and robotic approaches in terms of efficacy but with superior cosmesis. No difference was noted in terms of blood loss, operative time, visual analogue scale at discharge or length of hospital stay. Overall, the http://www.selleck.cn/products/azd4547.html quality of evidence of all above mentioned studies remains low (4/5 according to the Oxford Centre for Evidence-based Medicine). To this point all comparative analyses have been retrospective and therefore potentially subject to inherent biases. Indeed, well designed prospective trials are required to appropriately compare LESS to conventional laparoscopy, including validated quality of life and outcome analyses. LESS represents a novel approach to major urological procedures and underscores the evolution to progressively fewer incisions required to perform surgery. Aside from the obvious aesthetic advantages, it has been proposed that patients may experience less perioperative pain with fewer port-site related complications such as hernia or haemorrhage. Thus far preliminary comparisons suggest a modest if any recovery advantage for LESS procedures. Nevertheless well designed and conducted studies are still needed to compare LESS to laparoscopic procedures and determine if there truly may be any benefit to this approach. The eventual goal has been performance of natural orifice transluminal endoscopic surgery (NOTES) with access to the peritoneum and retroperitoneum through the body��s natural orifices.