Simultaneous Transvesical Laparoendoscopic Single-Port Diverticulectomy and Cystolithotripsy

Abstract

Introduction: Transvesical laparoendoscopic single-site surgery (T-LESS) is a novel minimally invasive approach that has been introduced to decrease the morbidity related to laparoscopic multiport placement and to improve cosmetic results. This technique was first used for foreign body removal from the bladder.1 We previously described a practical application of this method for bladder diverticulectomy.2 A potentially significant role of T-LESS has been noticed by other investigators.3 We present a video of the use of this approach for simultaneous bladder diverticulectomy and cystolithotripsy.4 Materials and Methods: A total of 10 patients underwent the T-LESS diverticulectomies. In two patients, additional procedures (ureteral reimplantation or cystolithotripsy) were carried out simultaneously, using the same access. In this video, we present the T-LESS diverticulectomy and cystolithotripsy in a 58-year-old male patient found to have a symptomatic diverticulum and intradiverticular multiple calculi, up to 2 cm in diameter. The following operative steps were employed: (1) introduction of the TriPort+ (Olympus) into the bladder; (2) establishing the pneumovesicum; (3) removal of the calculi either intact or after cystolithotripsy with the lithoclast probe; (4) dissection of the diverticulum with standard laparoscopic instruments; and (5) closure of the bladder wall defect with the V-Loc suture. An 18F Foley catheter was placed in the bladder for 7 days. Results: The procedure was completed effectively, without blood loss or any complications. No extra port was added. The operative time was 115 minutes, and the hospital stay was 2 days. In a 6-month follow-up, no bladder diverticulum or stones were observed, and the patient confirmed a significant reduction in preoperative symptoms. Conclusion: The T-LESS technique for the simultaneous removal of the bladder diverticulum and stones is a feasible and safe procedure. This combination of already existing techniques can be a valuable method for the treatment of more complex pathologies of the lower urinary tract. Nevertheless, further development of applicable instruments is needed. The authors have nothing to disclose. Runtime of video: 7 mins 48 secs