Laparoendoscopic single-site varicocelectomy compared with conventional laparoscopic surgery: a systematic review and meta-analysis

Purpose: To present a systematic review and meta-analysis comparing laparoendoscopics single-site varicocelectomy (LESS-V) versus conventional laparoscopic surgery (CTL-V). Methods: A literature search was performed using The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded and Google Scholar. Literature reviewed included meta-analyses, and randomized and nonrandomized prospective studies. We utilized 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. We used the Cochrane Collaboration's Review Manager 5.1 software for statistical analysis. Results: We identified six publications which strictly met our eligibility criteria. Meta-analysis of extractable data showed that LESS-V was better than CTL-V in postoperative pain (WMD: -0.46; 95 % 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) and cosmetic satisfaction (OR 6.86; 95 % CI 2.89-16.28; p < 0.00001). However, CTL-V was better than LESS-V in operative time (WMD 1.96 min, 95 % CI 0.96-2.96; p = 0.0001). There were no differences between LESS-V and CTL-V in hospital stay (WMD: -0.02 days, 95 % CI -0.39 to 0.35; p = 0.92) and postoperative complications (OR 1.13, 95 % CI 0.57-2.21; p = 0.73). Conclusions: This meta-analysis 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.