Single-port laparoscopic cystectomy and intracorporeal urinary diversion assisted by transurethral access: preliminary study

Abstract

Objective To make attempt for"no scar"cystectomy by pure LESS(laparoendoscopic single-site)surgery and transurethral NOTES(natural orifice transluminal endoscopic surgery)in pigs,so as to assess the feasibility and summarize the experience.Methods Female pigs weighing 30kg were given general anesthesia.A 2cm incision was made through the right lateral border of the rectus muscle,and the subcutaneous tissues and muscle layer were dissected bluntly with the Kelly clamp.The SILS port was introduced into the peritoneal cavity and the pneumoperitoneum was established.The bladder was dissected by the flexible forceps and scalpel.And the ureters and urethra were divided.Under the guidance of ureteroscopy,a 12mm trocar was introduced into the urethra.Through the transurethral access,the small intestine was divided by two Endo GIAs.The lateral-lateral anastomosis of intestine and the left side of ureter-intestinal anastomosis were performed with assistance of the transurethral access.After the specimens were retracted,the urethra was closed by 2-0suture.After the SILS port was removed,the right ureter and the small intestine for the stoma were pulled out of the peritoneal cavity.The right side of ureter-intestinal anastomosis was done outside of the body.Then the stoma was performed.Results Three cases were performed in a mean of(275±63)min(ranging from 210-335min)without additional trocars.Except for the stoma,there were no other incisions on the surface of the abdominal wall.Conclusion This "no scar"LESS radical cystectomy can be performed successfully with assistance of the transurethral access in pigs,but the operation is technically difficult.