935 SINGLE ACADEMIC INSTITUTION EXPERIENCE IN APPLICATION OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY IN ADULT AND PEDIATRIC UROLOGIC SURGERY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011935 SINGLE ACADEMIC INSTITUTION EXPERIENCE IN APPLICATION OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY IN ADULT AND PEDIATRIC UROLOGIC SURGERY Seth Cohen, George Chiang, Marvalyn DeCambre, Jonathan Silberstein, Sean Stroup, Jeffrey Woldrich, Wassim Bazzi, and Ithaar Derweesh Seth CohenSeth Cohen San Diego, CA More articles by this author , George ChiangGeorge Chiang San Diego, CA More articles by this author , Marvalyn DeCambreMarvalyn DeCambre San Diego, CA More articles by this author , Jonathan SilbersteinJonathan Silberstein San Diego, CA More articles by this author , Sean StroupSean Stroup San Diego, CA More articles by this author , Jeffrey WoldrichJeffrey Woldrich San Diego, CA More articles by this author , Wassim BazziWassim Bazzi San Diego, CA More articles by this author , and Ithaar DerweeshIthaar Derweesh San Diego, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.853AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adoption of Laparoendoscopic Single-site surgery (LESS) into pediatric surgical practice represents a further development of the minimally invasive surgical armamentarium for pediatric urology. The extension of LESS has been undertaken in partnership between the adult and pediatric urologic surgeons at the University of California, San Diego. METHODS Adult LESS (A-LESS) commenced in 1/2009, followed by initiation of Pediatric LESS (P-LESS) in 11/2009. Prior to initiation of P-LESS, pediatric urology faculty (GS, MD) proceeded with LESS-modified Society of American Gastrointestinal and Endoscopic Surgeons/Fundamentals of Laparoscopic Surgery curriculum emphasizing didactics, dry simulation drills, and preclinical live experience in partnership with the adult urologic surgeon (IHD). A-LESS were performed by transperitoneal (40) and retroperitoneal approach (20). Most (52) were performed by a single site approach with multiple trocars. All P-LESS were performed by transperitoneal SILS port (Covidien, Mansfield, MA, USA). Patient demographics, intraoperative parameters, outcomes, and complications were recorded. RESULTS 60 A-LESS and 15 P-LESS have been performed. A-LESS included 29 radical and 17 partial nephrectomies, 6 nephrectomies with renal vein thrombectomies, and 7 adrenalectomies. P-LESS included 7 unilateral and 4 bilateral nephrectomies, 1 ureteral reimplant, 1 varicocelectomy, and 2 orchidopexies. One adult case each required conversion to open, multiport laparoscopy, or placement of second trocar at separate site. One P-LESS converted to open surgery. Median age (years, range) for A-LESS was 62.5 (24–85.6), and for P-LESS was 6 (1.2–17.9 years). Median hospital stay (hours) for A-LESS was 60, and for P-LESS was 51.6. Median operative times (minutes, range) for A- and P-LESS were 154 (35–220) and 183 (58–564). Median estimated blood loss (mL, range) for A-LESS was 100 (5–500) and for P-LESS was 10 (0–100). Median discharge pain score for A-LESS (visual analog scale, range) was 1 (0–4); median pain score (Faces, Legs, Activity, Cry Consolability scale, range) on post-operative day 1 for P-LESS was 2.2 (0–4.4). Complications were noted in 4 (6.7%) A-LESS and 0 P-LESS. CONCLUSIONS Adaptation of LESS technique with excellent, reproducible and comparable outcomes was achieved by collaboration between adult and pediatric urologic surgeons. Further investigation is requisite to determine ultimate utility of LESS in adult and pediatric urology. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e375 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seth Cohen San Diego, CA More articles by this author George Chiang San Diego, CA More articles by this author Marvalyn DeCambre San Diego, CA More articles by this author Jonathan Silberstein San Diego, CA More articles by this author Sean Stroup San Diego, CA More articles by this author Jeffrey Woldrich San Diego, CA More articles by this author Wassim Bazzi San Diego, CA More articles by this author Ithaar Derweesh San Diego, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...