Homemade Single-port Research Articles

Suprapubic Transvesical Repair of Vesicovaginal Fistula Using a Homemade Laparoscopic Single-Port Device: Experience of 42 Patients.

Aim: Vesicovaginal fistula (VVF) is the most common urogenital acquired fistula, and has remained a scourge and of public health importance. VVF can be repaired by transvaginal approach, transabdominal approach or transvesical approach, but the optimal management is still debated.Methods: To demonstrate a suprapubic transvesical approach to repair VVFs using a homemade laparoscopic single-port device. A retrospective review of the medical records of 42 consecutive patients who underwent fistula repair for VVF at our center from January 2012 to March 2018 was performed. VVFs were repaired by a suprapubic transvesical approach using a homemade laparoscopic single-port device. Clinical data, perioperative data and outcomes were collected. The primary outcome was VVF successful closure rate, and secondary outcome was perioperative complications.Results: The mean age of the patients was 44.6 (27–58) yr. The mean follow-up time was 65.6 (32–118) mo. The VVFs were successfully closed in 37 (88.1%) patients after the first surgery, and failure was observed in five patients. Initial failures of all the five patients were cured after a second repair. No major complication occurred as defined by Clavien-Dindo class 2 or greater.Conclusions: Suprapubic transvesical approach to repair VVFs using a homemade laparoscopic single-port device is a simple, effective, and feasible approach offering ideal results without major complications.

Long-Term Outcomes of Laparoendoscopic Single-Site Nephrolithotomy for Caliceal Diverticular Calculi: A Case Series.

To evaluate the outcomes of laparoendoscopic single-site nephrolithotomy (LESS-NL) for symptomatic caliceal diverticular calculi. From November 2009 to March 2014, 11 cases of LESS-NL with a homemade single-port device for caliceal diverticular calculi were performed by a single experienced laparoscopic surgeon. All patients were assessed at postoperative 1 month, 1 year, and 3 years for symptom-free status and by CT for stone-free and caliceal diverticular obliteration status. All complications were categorized by the Clavien-Dindo classification. Demographic parameters and postoperative outcomes were retrospectively analyzed. All procedures were effectively performed without conversion to open or conventional laparoscopic surgery. Median patient age was 53 years (range 22-73), and median diverticular size was 26 mm (range 15-58). Six patients (54.5%) had multiple stones, and five patients (45.5%) had a single stone; median stone size was 20.6 mm (range 12.1-66.4). The transperitoneal approach was used in seven patients (63.6%) and retroperitoneal approach in four patients (36.4%). Median operative time was 161 minutes (range 110-250), median estimated blood loss was 50 mL (range 20-400), and median hospital stay was 4 days (range 3-6). An additional needlescopic instrument was used in five cases (45.5%). There were three cases (27.3%) of grade I complications (two postoperative fever, one ileus), and no intraoperative or major complications. Median visual analog scale score significantly improved by discharge day (from 4.9 preoperatively to 1.4; p = 0.003). After a median follow-up of 38 months (range 36-41), all patients were symptom free with no evidence of stone or caliceal diverticulum on imaging. LESS-NL is a safe, feasible, and definitive treatment option for symptomatic caliceal diverticular calculi.

The Safety and Feasibility of the Single-Port Laparoscopic Repair of Intraperitoneal Bladder Rupture.

To evaluate the efficacy and safety of laparoendoscopic single-site surgery (LESS) in the repair of intraperitoneal bladder rupture. All consecutive patients who underwent LESS for intraperitoneal bladder rupture in three hospitals in Korea were included prospectively in this study. LESS was performed using a homemade single-port device composed of an Alexis wound retractor and a surgical glove. Of the 22 patients, 18 were male. The mean age was 40.50 ± 11.83 years. The mean body mass index was 24.19 ± 2.61 kg/m2. The cause of rupture was trauma (n = 21) or iatrogenic injury (n = 1). The mean bladder rupture diameter was 3.41 ± 1.01 cm. LESS bladder rupture repair was completed effectively in all patients. The mean operative time was 89.05 ± 11.29 minutes. The mean length of hospital stay was 2.91 ± 0.53 days. Postoperatively, none of the patients required patient-controlled analgesia, and none developed major complications. The urethral Foley catheter was removed 7.68 ± 2.08 days after surgery. LESS repair of intraperitoneal bladder rupture, which involves a homemade single-port device, was a feasible and safe alternative to conventional laparoscopy in this case series.

Laparoendoscopic single-site simple nephrectomy using a magnetic anchoring system in a porcine model.

PurposeMagnetic anchoring devices may reduce the number of port sites needed in laparoscopic surgery. In this study, we prospectively assessed the feasibility of using a magnetic anchoring and guidance system (MAGS) in laparoendoscopic single-site (LESS) surgery performed by novices.Materials and MethodsA total of 10 LESS simple nephrectomies were performed with or without MAGS in a nonsurvival porcine model by 6 operators with no previous LESS surgery experience. After installation of the homemade single port, an intra-abdominal magnet was fixed to the renal parenchyma with suturing and stabilized by an external magnet placed on the flank so that the position of the kidney could be easily changed by moving the external handheld magnet. The length of the procedure and any intraoperative complications were evaluated.ResultsOperative time (mean±standard deviation) was shorter in the group using the magnetic anchoring device (M-LESS-N) than in the group with conventional LESS nephrectomy (C-LESS-N) (63±20.8 minutes vs. 82±40.7 minutes, respectively). Although all nephrectomies were completed uneventfully in the M-LESS-N group, renal vein injury occurred during dissection of the renal hilum in two cases of C-LESS-N and was resolved by simultaneous transection of the renal artery and vein with an Endo-GIA stapler.ConclusionsLESS-N using MAGS is a feasible technique for surgeons with no LESS surgery experience. Taking into account the 2 cases of renal vein injury in the C-LESS-N group, the application of MAGS may be beneficial for overcoming the learning curve of LESS surgery.

Clinical evaluation of a novel commercial single port in laparoendoscopic single-site surgery

IntroductionEndoscopic total extraperitoneal herniorrhaphy (TEP) has emerged as a recognized surgical method for adult inguinal hernia. To reduce port-site-related morbidity and improve postoperative convalescence, a novel surgical approach known as laparoendoscopic single-site surgery (LESS) TEP repair has been developed. AimTo compare the clinical efficiency of a novel commercial single port with a homemade single port in TEP groin hernia repair. MethodsSixty consecutive patients undergoing LESS TEP repair were enrolled in this trial with 31 in the homemade port group and 29 in the commercial single-port group. Preoperative, intraoperative, and postoperative factors were recorded. The patients were interviewed postoperatively at outpatient clinics. ResultsThe demographic data were comparable between the two groups. The median operative time was longer in the homemade port group than in the commercial port group (59.4 vs. 51.4 minutes, respectively, p = 0.04). The homemade port group was significantly associated with more port-related malfunctions than the commercial port group (19% vs. 0, respectively, p = 0.02). The postoperative results were comparable between the groups in pain scores, analgesic requirements, complications, and postoperative convalescence. ConclusionThe novel commercial single port studied is associated with less intraoperative malfunctions and improved the procedural efficiency of LESS TEP for groin hernia repair. Thus, a well-designed commercial port will be of significant benefit in overcoming the existing procedural inefficiencies of single-port surgery performed using a homemade port, which requires relatively time-consuming procedures and significant experience of the surgeon.

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy

Background Laparoendoscopic single-site (LESS) surgery through the retroperitoneal approach has been seldom reported. We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large, impacted ureteral calculi. Methods Between November 2011 and July 2013, retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape. Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy. We compared the operative time, complications, and surgical outcomes, retrospectively. Results All patients were completed without conversion to conventional laparoscopic or open surgery. The operative time of the LESS group and of the conventional laparoscopic group were (125.3±12.8) minutes and (116.9±14.4) minutes, respectively (P=0.119). The intraoperative blood loss was (42.9±8.9) and (43.4±14.7) ml, respectively (P=0.914). Postoperative radiologic evaluation revealed that the stones had been removed completely. Cosmetic results were superior in the LESS group (P=0.001). Conclusion Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.

Preliminary experience with transperitoneal laparoendoscopic single-site radical nephrectomy using a home-made single-port device in China

Background Laparoendoscopic single-site (LESS) surgery represents a technique to further reduce morbidity and scarring associated with surgery. We present our preliminary experience with transperitoneal LESS radical nephrectomy (RN) using a home-made single-port device in China. Methods From July 2010 to November 2011, eleven patients with renal tumor not greater than T2 underwent LESS-RN by an experienced laparoscopic surgeon. A home-made single-port device was used through a 5-cm umbilical incision. A combination of standard and articulating laparoscopic instruments was used. The sequence of steps of LESS-RN was similar to transperitoneal laparoscopic RN. Patient characteristics, perioperative variables and postoperative outcomes were recorded and analyzed. Results Except for two transperitoneal laparoscopic conversions and one hand-assisted laparoscopic conversion, the other procedures were completed successfully without conversion to open surgery. The mean operative time was 224.5 (155-297) minutes, estimated blood loss was 270.9 (50-900) ml, and hospital stay was 10.4 (5-15) days. The mean visual analog pain scale (VAPS) on the first postoperative day was 4.0/10. Final pathological analysis revealed renal cell carcinoma in all cases with a stage distribution of three T1a, five T1b, and three T2a tumors. With the mean follow-up period of 21.4 (12-28) months, all patients were alive without evidence of tumor recurrence or metastasis, and were satisfied with the appearance of the scars. Conclusion Transperitoneal LESS-RN using a home-made single-port device is technically feasible and safe in a selected group of patients (low body mass index and stage tumor) and has excellent cosmetic results. Although preliminary oncologic outcome is not compromised, the long-term evaluation of these patients is awaited.

Extraperitoneal transumbilical laparoendoscopic single-site radical prostatectomy using a homemade single-port device: 20 cases with midterm outcomes

To describe the surgical technique and to report the midterm outcomes of laparoendoscopic single-site radical prostatectomy (LESS-RP) with a homemade single-port device. Between August 2009 and October 2011, 20 LESS-RP procedures were performed in a single center by a high-volume surgeon. The surgical methods are outlined in the paper. Preoperative, perioperative, pathologic, midterm oncological, and functional outcomes data were analyzed. On average, patients were 66.1 years old, had a mean body mass index of 24.4 kg/m(2), and a mean prostate-specific antigen (PSA) value of 12.2 ng/ml. No conversion was required; however, a single additional 5-mm port was required in one case. The mean operative time was 248 min; mean estimated blood loss was 94 ml. The mean visual analog pain score at day 3 was 1.5 out of 10, and the mean hospital stay was 15.4 day. Pathology showed one focal positive margin (5 %) in a T3a patient, and mean Gleason score was 6.7. There were a total of four Clavien grade 2 complications. The median follow-up was 22.8 month (range 12-36 month). No PSA recurrence was detected during follow-up period; the potency rate after bilateral neurovascular bundle preservation was 60 % (3/5). Complete continence recovery (no pad) was observed in 85 % of the patients at 1 year, in 90 % at 2 years, and in all three patients at 3 years. LESS-RP is technically feasible and safe, with excellent cosmesis, low postoperative pain levels, and acceptable midterm oncological, and functional outcomes. Comparative investigation to conventional LRP is needed.

Laparoendoscopic Single-Site Urethrovesical Anastomosis Training in an Economical Porcine Model

Purpose: To develop an economical animal model for laparoendoscopic single-site surgery (LESS) urethrovesical anastomosis (UVA) training. Materials and Methods: A homemade single-port device was used and the uterus cervix and the ileum were chosen to simulate UVA to reduce costs. Ten trainees were randomly divided into two groups: the conventional LESS UVA (CLUVA) group and the transurethral assistant LESS UVA (TALUVA) group. In TALUVA, a laparoscopic forceps was inserted through the urethra to assist operation after the bladder neck was disconnected, whereas CLUVA followed the conventional steps. Anastomosis time and knotting time were recorded, and the learning curves of both groups were analyzed. After training, questionnaires were given to the trainees to assess the difficulties and the satisfaction of the training. Results: The final mean operating time significantly declined in both groups. Except for the first lesson, the trainees in the TALUVA group operated faster than those in the other group. The results from the questionnaires show that all trainees were satisfied with the training, and LESS UVA was considered more difficult in the CLUVA group than in the TALUVA group. Conclusions: The female porcine model for LESS UVA was feasible and cost-effective. TALVUA could effectively reduce the difficulties involved in LESS UVA.

Laparoendoscopic single-site radical cystectomy and urinary diversion: initial experience using homemade single-port device

Objective We report our initial experience with laparoendoscopic single-site surgery (LESS) for radical cystectomy and urinary diversion performed by a single surgeon using homemade singleport device.Methods From December 2010 and April 2011,7 LESS radical cystectomy were performed using a home-made single-port device composed of an inverted cone device of polycarbonate and a powderfree surgical glove.7 patients were all male,mean age was 66 (54-81) years and mean BMI (Body mass index) was 23.1 (20.9-25.3) kg/m2.The port was placed into a 5 cm periumbilical skin incision.The conventional laparoscope and laparoscopic instruments were inserted through the single-port.No additional ports were needed for radical cystectomy and bilateral standard pelvic lymphadenectomy.Cutaneous ureterostomy (3 cases) and ileal conduit urinary diversion (4 cases) were used for patients.Operative time,estimated blood loss,postoperative recovering time,oncologic data and complications were collected and analyzed.Results All the procedures were completed successfully.The mean operative time was 210.1 (155-280) minutes.The estimated blood loss was 300 (100-500) ml.The bowel recovering time 8 (4-12) days and postoperative hospital stay was 20 (13-34) days.One patient required a transfusion of 400 ml red blood cells.The pathologic evaluation revealed that there were one case of pT1N0M0,two of pT2aN0M0,two of pT2bN0M0 and two of pT3aN0M0.The high grade tumor in 4 cases and low grade in 3 cases.The surgical margins were negative in all the patients.All patients were node negative.After the operations,one case had a small bowel obstruction after three days and was treated by abrosia,fluid infusion and gastrointestinal decompression.Another patient died of cardiac disease at first day postoperative.Conclusions In our experience,LESS for radical cystectomy could be clinically feasible for selected patients,but it requires the learning curve. Key words: Laparoscopy; Surgical instruments; Gloves, surgical; Cystectomy

Laparoendoscopic Single-Site Pyelolithotomy With Use of a Carter-Thomason Needle Grasper

PurposeTo study the feasibility and safety of the procedure, we present our early experience with laparoendoscopic single-site (LESS) pyelolithotomy performed by use of a Carter-Thomason needle grasper.Materials and MethodsFour patients underwent LESS pyelolithotomy for the removal of renal pelvic stones. The patients' mean age was 57.8 years, and their mean body mass index was 23.01. We used a homemade single-port device made with a surgical glove that was inserted into a 2.5-cm periumbilical incision. The operation was performed transperitoneally by using a Carter-Thomason grasper. After removal of the stone, a double-J stent was placed in situ, and laparoscopic intracorporeal suturing was performed. No additional ports were used.ResultsAll surgeries were completed successfully without conversion to conventional laparoscopy or open surgery. The mean operative time was 124.5 minutes, and the mean estimated blood loss was 255.2 mL. There were no significant complications, except in one patient who required a blood transfusion. The mean duration of hospital stay was 8.3 days. The mean stone size was 3.9 cm. Chemical analysis of the stones showed that three patients had calcium-containing stones and one patient had a uric acid stone. Postoperative radiologic study showed a stone clearance rate of 100%.ConclusionsOur results, albeit limited, showed that LESS pyelolithotomy is a feasible and safe procedure. Especially with the use of a Carter-Thomason needle grasper, this operation can be performed without an additional port.

A Novel Approach for the Resection of Low Rectal Cancer

Our novel approach is a hybrid between cylindrical abdominoperineal resection and single-incision laparoscopic surgery (SILS). We report the clinical application of this technique and present preliminary data that shows this approach to be an effective tool for resection of low rectal cancer. Twenty patients with endoscopy-considered and biopsy-proven malignant lesions were required to undergo abdominal computed tomography examination for determining tumor stage. In addition, all patients had taken in digital rectal examination again on the surgery day. Perioperative management of patients was executed according to management of patients in fast-track surgery. First, cylindrical abdominoperineal resection was performed with the patients in the prone jackknife position to peritoneal reflection, then we turned the patients to the supine position and SILS was performed with the homemade single-port device. The average distance from the anal verge was 2.60±1.14 cm and the mean tumor diameter confirmed by pathology measured to be 3.00±1.08 cm, and the circumferential margin was negative in all the specimens. The mean fabrication and set-up time of the homemade SILS device was 7.75±1.21 minutes and the average operating time was 138.55±9.32 minutes with minimal blood loss (20.5±5.83 mL). There were no conversions from SILS to conventional laparoscopy. On average, oral intake can often be successfully initiated 7.35±1.35 h after surgery, with the first passage of flatus from the colostomy occurring 2.55±0.76 d postoperation. Function hospital stay was 4.25±0.97 d with no undue sequelae. During the 6-month-long follow-up stage, no morbidity or mortality was observed except in 2 patients with poor union in perineum incision. Cylindrical abdominoperineal decection combined with SILS is a feasible alternative for low rectal cancer, providing benefits like leaving enough exposure for operation, reducing trauma to surrounding organs, almost completely avoiding circumferential involvement, and allowing fast postoperative recovery.

Transumbilical laparoendoscopic single-site radical nephrectomy: primary experience and results

Objective To evaluate the safety and primary outcomes of transumbilical laparoendoscopic single-site radical nephrectomy (LESS-RN) by using home-made single-port device. Methods From July 2010 to November 2011,we had performed transumbilical LESS-RN on eleven renal cell carcinoma patients by using the home-made single-port device.There were 5 males and 6 females in this group.The mean age was 49 (37 -68) years and mean body mass index was 24.2 (18.4 -30.4) kg/m2.Ultrasound and CT scan revealed 11 renal tumors (7 on left and 4 on right),with 3 on the upper pole,4 in the middle and 4 in the lower pole.There were 2 cases with suspicious lymph node metastasis and one case with renal cyst.There was no distant metastasis.The intracorporal procedure was similar to conventional laparoscopic radical nephrectomy. Results Except two cases converted to conventional laparoscopic RN and one case converted to hand-assisted laparoscopic RN,the other procedures were completed successfully without open conversion.The mean operative time was 225 min (155 -297 min) and mean estimated blood loss was 271 ml (50 -900 ml).Postoperative results showed that all cases were renal cell carcinoma and there were 3 cases in T1a,5 cases in T1b and 3 cases in T2a.The mean visual analog pain scale (VAPS) was 4 (3 -6),and mean hospital stay was 10 d (5 -15 d).With the mean follow-up of 17 months (8 -24 months),all patients were alive with no evidence of local recurrence or metastasis.Patients were satisfied with the cosmetic results of the wound recovery. Conclusions Transumbilical LESS-RN using home-made single-port device is a safe approach in selected patients and has excellent cosmetic results. Primary oncologic outcomes are good.However,we will still need large clinic trials to further evaluate the efficacy and safety of LESSRN. Key words: Renal cell carcinoma; Laparoendoscopic single-site surgery; Nephrectomy; Surgical technique

Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter

To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval ureter and our initial experience with this method in 4 patients. From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand suturing. A double-pigtail ureteral stent assembly was implanted in 3 of the 4 patients. All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The mean operating time was 105min (range, 90-135min). The mean blood loss was 18mL (range, 5-50mL). None of the patients required blood transfusion. The double-pigtail ureteral stent was removed 4-6weeks postoperatively. The mean postoperative hospital stay was 7.3days (range, 6-9days). No intraoperative or postoperative complications occurred. At a mean follow-up of 10months, excellent improvement in the ureteral obstruction was observed. We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term follow-up of more cases is needed to confirm its benefits.

Laparoendoscopic Single-site Repair of Bladder Rupture Using a Home-made Single-port Device

We report our initial experience with a laparoendoscopic single-site (LESS) repair of a bladder rupture using a home-made single-port device. A 37-year-old man presented to the emergency department with complaints of voiding difficulty and gross hematuria after blunt trauma. Cystography and computed tomography revealed an intraperitoneal bladder rupture. The patient underwent LESS repair of a bladder rupture using the Alexis wound retractor, which was inserted through the umbilical incision. A home-made single-port device was made by fixing 6½ surgical gloves to the outer rim of the retractor and securing the glove finger to the end of 3 trocars with a tie. Using the flexible laparoscopic instruments and rigid instruments, LESS surgery was performed using a procedure similar to conventional laparoscopic surgery. The patient did not have any voiding problem after removal of the urethral Foley catheter on the 10th postoperative day. To our knowledge, this is the first published report of LESS repair of a traumatic bladder rupture using a home-made single-port device in the literature.

Single-Site Surgery for Simultaneous Totally Extraperitoneal Bilateral Herniorrhaphy and Transperitoneal Radical Nephrectomy in One Patient

This study reports a case undergoing laparoendoscopic totally extraperitoneal herniorrhpahy and transperitoneal laparoscopic radical nephrectomy through transumbilical single-site incisions. A 56-year-old man presented with incidental left renal tumor and bilateral inguinal hernia. Accordingly, a homemade single-port in subumbilicus was applied for totally extraperitoneal herniorrhpahy, following which the incisional wound was extended upward for transperitoneal radical nephrectomy as well. No extraumbilical port was required. Pathology confirmed the diagnosis of renal cell carcinoma. The peri- and postoperative course was quite smooth with rapid recovery, and the patient was discharged home on the fifth postoperative day. The laparoendoscopic single-site surgery with homemade single-port allowed extraperitoneal and transperitoneal procedures to be carried out at the same time, which was feasible and safe with negligible complications. Performing 2 procedures with single-site incision greatly diminished the number of port site incisions and offered obvious cosmetic advantage.

Endoscopic Single-Port Lumbar Sympathectomy: Preliminary Experience

Introduction: Retroperitoneoscopic lumbar sympathectomy was first described in 1973.1 For its minimal invasiveness, the technique was then widely accepted for various conditions like plantar hyperhydrosis, nonreconstructive peripheral vascular disease (PVD), and reflex sympathetic dystrophy.2–4 The novel technique endoscopic single-port surgery (laparoendoscopic single-site surgery [LESS]) has been performed in various operations that aim at performing laparoscopic surgery by consolidating all ports within a single skin incision. The most obvious advantage of LESS is its cosmetic outcome compared with conventional laparoscopic procedure (one port vs. at least three ports). To date, the feasibility and safety of LESS lumbar sympathectomy have not been reported in the literature. Here, we report our preliminary experience in LESS lumbar sympathectomy. Materials and Methods: Between March 2010 and July 2010, four consecutive LESS lumbar sympathectomies were performed in two cases. Surgical indications were refractory nonreconstructable PVD and plantar hyperhidrosis. LESS lumbar sympathectomy was performed with a homemade single port created using an Alexis wound retractor through a 2-cm incision beneath the tip of 12th rib.5 Standard 5-mm 30° laparoscope and straight laparoscopic instruments were used for subsequent manipulation. The video includes a brief review of a patient with refractory nonreconstructable PVD that operated with the same technique. Results and Conclusions: The procedure was completed without multiport laparoscopic or open conversion. The mean operative time was 67 minutes (range 55–110). The histological analysis of the resected ganglions revealed ganglion cells and nerve tissues. The skin temperature of the sole of the foot increased immediately after ganglion resection. The case of hyperhidrosis had anhidrosis of both feet at 1 month of follow-up and the case of PVD had significant relive of pain postoperatively. The mean hospital stay was 2.5 days. There was no operation-related complication. The potential benefit of single-port surgery that could only be concluded in this study is its cosmetic effect. According to our unpublished randomized study, the average final scar length of three 5-mm trocars is 3 cm for a standard laparoscopic surgery. Thus, the cosmetic advantages of single-port surgery are not only reduced number of incisions but also the reduced final total scar length. However, further prospective study is warranted to provide the evidence concerning the clinical benefits of single-port surgery other than cosmetic effect. In conclusion, our preliminary experience revealed that endoscopic single-port lumbar sympathectomy is a safe, feasible, and reproducible procedure. Shiu-Dong Chung, M.D., Tin-Chou Li, M.D., and Ta-Chung Shen, M.D., contributed equally to this work. No competing financial interests exist for any of the authors. Runtime of video: 7 mins 8 secs

Single-Port Access Laparoscopy-Assisted Vaginal Hysterectomy: Our Initial Experiences with 100 Cases

Objectives. To present our initial experiences with laparoscopically assisted vaginal hysterectomy performed using homemade transumbilical single-port system. Materials and Methods. We reviewed the medical records of one hundred patients who underwent single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH). SPA-LAVH was performed with homemade single port system and conventional rigid laparoscopic instruments. Results. All procedures were successfully completed through the single-port system and vagina without need for extraumbilical puncture or conversion to laparotomy. The median patient age was 48.2 ± 6.5 years. Thirty-three patients had history of past abdominopelvic surgery. The median total operative time, largest dimension of the uterus, and weight of the uterus were 73.1 ± 24.6 min, 10.5 ± 2.1 cm, and 300.8 ± 192.5 gram, respectively. The median decline in the hemoglobin from before surgery to postoperative day 1 was 1.8 ± 0.9 g/dL. Bladder injury in occurred one patient who was repaired through intraoperative laparoscopic suture. The postoperative course was uneventful in most patients except for three who had a transient paralytic ileus, five who had pelvic hematoma, but they were recovered following conservative managements. No port-related complications were noted, and the cosmetic results were excellent. Conclusions. SPA-LAVH is technically safe procedure, and the homemade single-port system offers reliable access for single-port surgery.

Laparoendoscopic Single-Site Surgery for Benign Urologic Disease with a Homemade Single Port Device: Design and Tips for Beginners

PurposeA single surgeon skilled in conventional laparoscopic surgery used laparoendoscopic single-site surgery (LESS) to treat benign urological diseases. This study reports our surgical results and introduces a simple technique with tips based on our experience.Materials and MethodsLESS surgery was performed on 116 patients by use of a homemade single-port device composed of an Alexis wound retractor and a powder-free surgical glove. Cases were 44 varicocelectomies (including 8 bilateral cases), 38 renal cyst marsupializations (including 3 bilateral cases), 26 ureterolithotomies (with 1 concomitant ureterolithotomy and contralateral renal cyst marsupialization), 4 prostatic enucleations, and 4 bladder rupture repairs. The mean patient age was 44.43±16.46 years (range, 11 to 76 years), and the male-to-female ratio was 87:29.ResultsIn one ureterolithotomy case, LESS was converted to conventional laparoscopic surgery. The mean operative time was 87.03±45.03 minutes, the estimated blood loss was 61.90 ml (range, 0 to 2,000 ml), and the mean hospital stay was 3.03±2.12 days. Two patients underwent single-port transvesical enucleation of the prostate (STEP) requiring patient-controlled anesthesia. No patients developed major complications, and all patients were satisfied, with 75.86% expressing a high degree of satisfaction.ConclusionsWe report successful treatment outcomes for LESS in 116 cases of benign urological disease. Our findings suggest that LESS can replace conventional laparoscopy.

Single-site multi-channel transumbilical laparoscopic implantation of long-term peritoneal dialysis catheters: initial clinical experience with 2 cases

Objective To present our initial experience of single-port multi-channel laparoscopic urologic surgery for the transumbilical laparoscopic implantation of long-term peritoneal dialysis catheters.Methods On May 17th and August 18th,2009,2patients underwent single-port multi-channel laparoscopic surgery for chronic renal failure(CRF)due to benign arteriolonephrosclerosis and type 2diabetes mellitus(DM).The flexible laparoscopic instrumentation with a homemade single port and multichannels was used for the transperitoneal approach.Results The 2cases were completed without conversion to standard laparoscopic or laparotomy.The operation time for implantation was 15-25min,and the estimated blood loss was about 20ml.The patients were discharged 1day after operation and were followed up for 6-8months.Conclusion Singleport multi-channel laparoscopy is feasible,safe,and effective for transumbilical laparoscopic implantation of long-term peritoneal dialysis catheters,with the advantages of minimal incision and better cosmetic benefit.