Korean J Urol.  2011 Jan;52(1):31-38.

Laparoendoscopic Single-Site Surgeries: A Single-Center Experience of 171 Consecutive Cases

• Choi KH
• Ham WS
• Rha KH
• Lee JW
• Jeon HG
• Arkoncel F
• Yang SC
• Han WK

Abstract

PURPOSE
We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution.
MATERIALS AND METHODS
Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases.
RESULTS
Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma.
CONCLUSIONS
Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.

Keyword

Kidney; Laparoscopy; Minimally invasive surgical procedures; Robotics; Ureter

MeSH Terms

Adrenalectomy
Cystectomy
Follow-Up Studies
Gloves, Surgical
Humans
Intraoperative Complications
Kidney
Laparoscopy
Nephrectomy
Operative Time
Orchiectomy
Postoperative Complications
Prospective Studies
Robotics
Surgical Procedures, Minimally Invasive
Ureter
Urologic Diseases

Figure

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  FIG. 1 Conventional laparoendoscopic single-site surgery. (A) A homemade single-port device and laparoscopic instruments for right radical nephrectomy. (B) Renal hilar dissection with articulating hook electrocautery. (C) Ureteropelvic reconstruction with a straight laparoscopic needle holder. We used the first stitch string for internal traction of the ureter. A double-J stent was inserted in the distal ureter; the proximal coil was not yet inserted. (D) Urachal mass excision using an additional 2 mm MiniLap Alligator clamp (Stryker, NY, USA, left).

• 

  FIG. 2 Robotic laparoendoscopic single-site partial nephrectomy. (A) A homemade single-port device was established by inserting two 12 mm trocars and two 8 mm trocars through the fingers of the surgical gloves. The scope was placed at a 30° upward angle to the robotic arms. (B) Renal vessel clamping.

• 

  FIG. 3 Abdomen 1 month after surgery.

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