768 UROLOGIC LAPAROENDOSCOPIC SINGLE SITE SURGERIES USING HOMEMADE SINGLE PORT DEVICE: A SINGLE CENTER EXPERIENCE OF 200 CONSECUTIVE CASES

Abstract

INTRODUCTION AND OBJECTIVES: With advancements in laparoscopic instruments, consideration of cosmesis and trends for minimal invasiveness, the number of laparoendoscopic single site surgery (LESS) has been performed for diverse urologic diseases. We report our experience with 200 patients who underwent LESS surgery using a homemade single port device in a single institution. METHODS: Between December 2008 to October 2010, 200 consecutive LESS urologic operations were done in Shinchon Severance hospital. Conventional LESS (C-LESS) and robotic LESS (RLESS; da Vinci S, Intuitive Surgical, USA) procedures were performed by three expert laparoscopic surgeons. All procedures were done using a homemade single port device with size 7 non-powdered surgical gloves and the Alexis¢c wound retractor which was inserted through a 2 to 4cm umbilical incision. The port device was made by placing gloves to the retractor outer ring by suturing and repeated folding to prevent air leak. A homemade single port was established by inserting three or four 12-mm and 8-mm trocars through the fingers of a surgical gloves and securing it to the port with rubber band. In R-LESS, an additional trocar was inserted in the midline below the subxiphoid process or alongside the homemade single port to establish a 12-mm hybrid port if needed. RESULTS: Of the 200 patients, 111 underwent C-LESS and 89 underwent R-LESS. Mean patient age was 53 years, mean operative time was 190.9 minutes, and mean estimated blood loss was 204 mL. Intraoperative complications occurred in seven cases (3.5%), and postoperative complications in nine cases (4.5%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification). Conversion to mini-incision open surgery occurred in eight (4%) cases. Regarding oncologic outcomes, there were five cases of distant metastasis in total 101 cases of cancer operation including aggressive progression of Ewing sarcoma and leiomyosarcoma. Two bladder recurrence was occurred in nephroureterectomy cases. Operative records, pathologic results and complication data are described in Table 1. CONCLUSIONS: LESS is technically feasible and safe for various urologic diseases. However, surgical experience and long-term follow-up are needed to test the superiority of LESS.