Port Approach Research Articles

Minimally invasive surgery for paediatric inflammatory bowel disease: Personal experience and literature review

The incidence of paediatric inflammatory bowel disease (PIBD) has dramatically increased in the last 20 years. Although first reported in mid 1970s', diagnostic laparoscopy has started to be routinely adopted in paediatric surgical practice since late 1990s'. Minimally invasive surgery was first limited to diagnostic purposes. After 2002 it was also applied to the radical treatment of PIBD, either Crohn's disease (CD) or Ulcerative colitis. During the last decade minimally invasive approaches to PIBD have gained popularity and have recently became the "gold standard" for the treatment of such invalidating and troublesome chronic diseases. The authors describe and track the historical evolution of minimally invasive surgery for PIBD and address all available opportunities, including most recent advancements such as robotic surgery, single port approaches and minimally invasive treatment of perianal fistulising CD. A systematic review of all series of PIBD treated with minimally invasive approaches published so far is provided in order to determine the incidence and type of patients' complications reported up to present days. The authors also describe their experience with minimally invasive surgery for PIBD and will report the results of 104 laparoscopic procedures performed in a series of 61 patients between January 2006 and December 2014.

Uniportal video assisted thoracoscopic lobectomy: going directly from open surgery to a single port approach.

Uniportal video-assisted thoracoscopy (VATS) has gaining a special place in the thoracic surgery scenario; nowadays even major pulmonary resections can be performed through this approach. We hereby review our initial experience with uniportal VAT lobectomy, performed passing directly from the open approach to a single port approach. We attempted 26 lobectomies through VATS with a single incision of about 5 cm and 22 of them were completed: eight left lower lobectomies, six right upper lobectomies, five left upper lobectomies and three right lower lobectomies. At pathological staging all but four patients were stage I; three patients were T2N1M0 and one had a micrometastasis in a lymph node of station 7 (T1N2M0-Stage IIIA) and they all underwent adjuvant chemotherapy. No perioperative mortality was observed. One patient had a myocardial infarction in the first postoperative day requiring placement of four stents and another one required thoracentesis after drainage removal. The mean time for drainage removal was 3 days and the length of hospitalization was 4.2±1.1. Pain as measured by the visual analogical scale (VAS) scale was graded as 4.9, 2.6 and 0.5 during the first postoperative day, at discharge and after 1 month respectively.

Five Year Experience With Single-Port Donor Nephrectomy as a Standardized Approach.

In 2009, our center adopted a single-port transumbilical approach for living kidney donation and accepted this as our standardized approach after initial success. Our first reports demonstrated equivalent donor and recipient outcomes and improved patient satisfaction. Here we update our results with our 5 year experience and provide follow up of over 300 cases. Methods: A retrospective review of all single-port donor nephrectomies was performed under IRB approval. Operative and hospital records were collected and utilized to create a database of these patients. Results: Between 2009 and 2014, 338 cases were initiated via a single port approach. Left nephrectomy was performed in 97% of cases. Thirty-two cases (9.5%) required placement of additional ports due to technical challenges with renal mobilization or visualization due to intraabdominal fat. Multiple vessels were present in 41% of cases. Incisional hernia developed in 8 cases (2.4%). One patient required conversion to an open procedure for bleeding. Two patients required a return to the OR in the perioperative period: 1 for a bowel injury and 1 for an internal hernia. Two patients required post-operative blood transfusion. Operative time decreased between the first 100 cases and the subsequent cohort. Conclusions: Single port donor nephrectomy can be reliably performed with safe outcomes. As our prior report indicated, a low rate of incisional hernia exists, but this rate has has not increased with prolonged follow-up. Our earlier work supporting improved patient satisfaction, combined with this present large series of excellent outcomes, suggest that the single port approach should be the standard surgical approach in centers with appropriate technical expertise.

Potentials of e-Navigation – Enhanced Support for Collision Avoidance

The e-Navigation initiative of IMO and IALA has stimulated and inspired a number of ambitious research projects and technological developments in the maritime field. The global transportation of goods is not only facing rapidly growing ship dimensions but also increasing industrial off shore activities, changing the relation between the need of areas for safe and reliable vessel traffic and its availability. Off shore activities is increasingly limiting the available navigable spaces and concentrating traffic flows, especially in coastal waters and port approaches. Enhanced technical systems and equipment with numerous added functionalities are in use and under further development providing new opportunities for traffic surveillance and interaction. Integrated Bridge and Navigation Systems on board modern ships not only support the bridge teams and pilots on board, but also allow for more comprehensive shore-based traffic monitoring and even allow for re-thinking of existing regimes and procedures on traffic management. A sophisticated manoeuvring support tool using fast real-time simulation technology and its application for on board support as well as for its potential integration into enhanced shore-based monitoring processes when linked with the Maritime Cloud will be introduced. The potential for contribution to generate harmonized collision warnings will be discussed and explained. This paper is a reviewed and extended version of (Baldauf, Benedict & Gluch, 2014).

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma and evaluated the potential advantages of each. From January 2010 to December 2010, all 23 patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introduced the reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stage prostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serum PSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates and post-operative pain. There was a significant difference in operative time between the 2-port RP and LRP groups (286.5 ± 63.3 and 351.8 ± 72.4 min: p=0.0019, without any variation in blood loss (including urine) (945.1 ± 479.6 vs 1271.1 ± 871.8 ml: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RP group, but without significance (5.6 ± 1.8 vs 8.0 ± 5.6 days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8 mg/patient in 2-port RP and 50.0mg/patient in LRP. Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

Endoscopic single port skin-sparing total mastectomy with periareolar incision: Early results.

77 Background: Early-stage breast cancer, such as DCIS, may force to complete removal of the mammary gland because of its wide spread in the breast. For such cases, skin-sparing mastectomy (SSM) should be recommended. However, the conventional oncoplastic surgery leaves some ugly scars on the breast due to large skin incisions. By applying the endoscopic video-assisted breast surgery (VABS), we can provide more aesthetic surgery with single periareolar port approach, leaving only a small and inconspicuous scar on the breast. Methods: VABS of SSM consists of periareolar skin incision, dissection of whole mammary gland, sentinel node (SN) biopsy, and axillary node (AN) dissection. After SSM, the breast reconstruction was performed by the delayed or simultaneous method. We use the implant for simultaneous reconstruction. SN biopsy was performed endoscopically with only 1 cm incision in the axilla which was marked with 3D-CT lymphography prior to surgery. For SSM, we made a skin incision of 2.5 - 3.5 cm incision at the foot-side edge of the areola, to preserve blood flow around the areola. We cut across the gland near the nipple and quickly checked the transected stump by fast frozen section. Subcutaneous detachment was applied to the entire gland. Back of the gland was peeled just above the pectoralis major muscle fascia. The liberated gland was removed through the port with a plastic bag. Results: We performed VABS on 300 patients since 2001, and SSM on 30 patients. Tumor size is 1.6 cm on average. Age is 57.2 years. 23 nipples were preserved. 17 cases were DCIS. 4 were invasive lobular carcinoma. 9 were invasive ductal carcinoma. 2 cases had SN metastasis. One case had AN metastasis. Between VABS and the conventional surgery, there was no difference in the amount of blood loss and operation time. Postoperative aesthetics was particularly good after simultaneous reconstruction. They had less sensory disturbance and high satisfaction. After 38 months, there have been no distant metastases, no postoperative deaths, and one local recurrence). Conclusions: VABS SSM with periareolar skin incision approach makes better aesthetic results.

Adnexal Masses Treated Using a Combination of the SILS Port and Noncurved Straight Laparoscopic Instruments: Turkish Experience and Review of the Literature

Objective. To report our experience treating adnexal masses using a combination of the SILS port and straight nonroticulating laparoscopic instruments. Study Design. This prospective feasibility study included 14 women with symptomatic and persistent adnexal masses. Removal of adnexal masses via single-incision laparoscopic surgery using a combination of the SILS port and straight nonroticulating laparoscopic instruments was performed. Results. All of the patients had symptomatic complex adnexal masses. Mean age of the patients was 38.4 years (range: 21–61 years) and mean duration of surgery was 71 min (range: 45–130 min). All surgeries were performed using nonroticulating straight laparoscopic instruments. Mean tumor diameter was 6 cm (range: 5–12 cm). All patient pathology reports were benign. None of the patients converted to laparotomy. All the patients were discharged on postoperative d1. Postoperatively, all the patients were satisfied with their incision and cosmetic results. Conclusion. All 14 patients were successfully treated using standard, straight nonroticulating laparoscopic instruments via the SILS port. This procedure can reduce the cost of treatment, which may eventually lead to more widespread use of the SILS port approach. Furthermore, concomitant surgical procedures are possible using this approach. However, properly designed comparative studies with single port and classic laparoscopic surgery are urgently needed.

Ureteral Obstruction Swine Model through Laparoscopy and Single Port for Training on Laparoscopic Pyeloplasty

This study aims firstly to assess the most adequate surgical approach for the creation of an ureteropelvic juntion obstruction (UPJO) animal model, and secondly to validate this model for laparoscopic pyeloplasty training among urologists.Thirty six Large White pigs (28.29±5.48 Kg) were used. The left ureteropelvic junction was occluded by means of an endoclip. According to the surgical approach for model creation, pigs were randomized into: laparoscopic conventional surgery (LAP) or single port surgery (LSP). Each group was further divided into transperitoneal (+T) or retroperitoneal (+R) approach. Time needed for access, surgical field preparation, wound closure, and total surgical times were registered. Social behavior, tenderness to the touch and wound inflammation were evaluated in the early postoperative period. After ten days, all animals underwent an Anderson-Hynes pyeloplasty carried out by 9 urologists, who subsequently assessed the model by means of a subjective validation questionnaire.Total operative time was significantly greater in LSP+R (p=0.001). Tenderness to the touch was significantly increased in both retroperitoneal approaches, (p=0.0001). Surgeons rated the UPJO porcine model for training on laparoscopic pyeloplasty with high or very high scores, all above 4 on a 1-5 point Likert scale.Our UPJO animal model is useful for laparoscopic pyeloplasty training. The model created by retroperitoneal single port approach presented the best score in the subjective evaluation, whereas, as a whole, transabdominal laparoscopic approach was preferred.

Accuracy Performance Of E-Loran Receivers Under Cross-Rate Interference Conditions

Abstract According to a recent Business Case produced by the General Lighthouse Authorities of the United Kingdom and Ireland (GLAs), e-Loran is the only system that, when combined with GNSS, can achieve cost effective resilient Positioning, Navigation and Timing (PNT) by 2018 for maritime e-Navigation. The GLAs currently operate a trial e-Loran service from Harwich, UK and are working towards establishing e-Loran Initial Operational Capability (IOC) in the seven busiest UK ports and port approaches by mid-2013. A future extension of e-Loran coverage to the entire GLA service area will require the installation of additional transmitting stations. When planning the installation of e-Loran transmitters service providers will need a good understanding of the effects of the new signals on the system’s performance. Since all e-Loran stations share the same frequency band and the e-Loran signals propagate over vast distances, special attention needs to be paid to the issue of intra-system interference. This is also referred to as Cross-Rate Interference (CRI) and is inherent to the way e-Loran operates. In this paper we examine the impact of CRI on the position accuracy performance of e-Loran receivers. First, a signal processing model for a typical e-Loran receiver is developed. This could provide the e-Loran community with a unified framework for receiver performance evaluation. Numerical and, where possible, analytical results obtained from the model are then presented, describing the achievable accuracy performance under different interference conditions. The theoretical results are also compared to those obtained from measurements made on a commercially available receiver driven by a signal simulator. Our analysis shows that modern e-Loran signal processing algorithms can achieve a substantial reduction of the negative effects of CRI. However, there is still an appreciable residual effect, which should be taken into account when designing future e-Loran networks and determining their coverage and performance

Laparoendoscopic radical cystectomy with orthotopic ileal neobladder through umbilical single port

ContextRadical cystectomy with orthotopic derivation is one of the most complex urological techniques, although laparoscopic surgery has made this procedure increasingly less invasive. ObjectiveTo provide an updated review of the single port approach to carry out radical surgery due to bladder cancer. Evidence acquisitionA comprehensive review of the literature was performed using Medline and Embase to discover the accumulated experience of the viability of carrying out laparoendoscopic radical cystectomy, pelvic lymphadenectomy and orthotopic neobladder using the LESS (laparoendoscopic single site surgery) approach. Our experience with this approach is also presented and the technique used with the reusable KeyPort® system developed by Richard Wolf is described. Evidence synthesisRadical treatment of bladder cancer is possible in men and women using a single port and even performance of ileal neobladder, as reconstructive procedure in these patients. The surgical technique, post-operative cares and result obtained in our center are described. The accumulated experience worldwide describes 25 cases of radical cystectomy performed using different single port systems, 14 of them with orthotopic intestinal neobladder. ConclusionThe KeyPort® umbilical cystectomy constitutes in our setting the least possible invasive alternative to efficiently treat muscle-invasive bladder cancer, with excellent esthetic result, minimum post-operative pain and short hospital stay. The umbilical scar decreases the analgesic requirements and it ends up being practically invisible. This supposes an important step in the development of the minimally invasive surgery for bladder cancer.

The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax: a retrospective study

BackgroundThoracoscopic surgery is a commonly used endoscopic surgical treatment approach in patients with primary spontaneous pneumothorax. The conventional thoracoscopic approach utilizes three or more small wounds for surgery. Currently, a single port approach is a potential alternative procedure in general thoracoscopic surgery. We investigated whether a single-port approach is suitable as a first-line endoscopic approach for all patients with primary spontaneous pneumothorax requiring surgery.MethodsFrom July 1st, 2008 to Dec 31, 2009, a total of 62 patients was included in this study. All the patients were admitted to our ward because they had surgical indications for surgery. Twenty-six patients underwent conventional three-port thoracoscopic surgery and thirty-six underwent single-port thoracoscopic surgery. All of the clinical data were analyzed retrospectively. Variables were compared and analyzed to determine the outcomes of the different surgical approaches.ResultsThe mean age of the 62 patients was 27.2 years. Forty-nine patients were men and thirteen patients were women. The mean time required for the operation was 61.6 minutes. There was one patient who had a recurrence in single-port group and 2 patients had a recurrence in three-port group during the period of follow-up. The average pain scores at 24 and 48 hrs after the operation were similar, but the pain scores at 72 hrs in the single-port group were better than the three-port group. There was no case that required conversion from a single-port to multiple wound approach in this study. There was no immediate postoperative recurrence. The follow-up duration was greater than 12 months.ConclusionThis study showed that single-port thoracoscopic surgery is a feasible and reasonable first-line endoscopic approach in the surgical treatment of primary spontaneous pneumothorax.

Robotic Thyroidectomy via a Transaxillary Approach

Objective: Recently, various robotic surgical procedures have been performed, and most reports have proved that the application of robotic technology for surgery is technically feasible and safe. The feasibility and safety of robotic thyroid surgery was examined via transaxillary single port approach without gas insufflation. Method: The study included 109 consecutive patients with papillary thyroid cancer who underwent robot-assisted endoscopic thyroid surgery using a gasless transaxillary single port approach by a single surgeon (Y.W.K.) between May 2010 and August 2011 at the department of otorhinolaryngology, Yonsei University College of Medicine. Results: The console time for 50 hemithyroidectomy (HT) with ipsilateral central compartment neck dissection (CCND) was 45.67 min, and that of 59 total thyroidectomy (TT) with ipsilateral or bilateral CCND was 93.77 min. The amount of drainage was 194.07 mL, and the duration of drainage was 3.5 days. The hospital stay was 6.09 days. Mean primary tumor size was 6.58 mm. The average number of lymph nodes resected was 3.51 (range, 1-19). Temporary hypoparathyroidism encountered with 24 patients in the TT group (40.7%, 24/59). There were 5 cases of temporary recurrent laryngeal nerve injury and 12 of seromas. One case of temporary brachial plexus injury occurred due to arm positioning. Conclusion: The technique of robotic thyroid surgery using a gasless transaxillary single port approach is a feasible, safe, and effective method for selected patients with thyroid cancer. The authors suggest that application of robotic technology for endoscopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.

Exploring non-technical miscommunication in vessel traffic service operation

Vessel traffic services (VTS) are maritime traffic monitoring systems used in port approaches, confined or congested waters. VTS operators (VTSOs) monitor a specific geographical area and support and direct ships that sail through the area, primarily making the navigating officer or pilot of each ship aware of the current traffic situation, local weather and geographical conditions. We used an interactive mid-fidelity simulation as a knowledge eliciting tool to explore the work situation of VTSOs. During the simulation, VTSOs from a VTS centre in Sweden ran a scenario based on a normal traffic situation in their local fairway. Results indicate that the VTSOs, even though they are well aware of crucial events in the fairway, at times choose not to inform navigating officers or pilots of these safety aspects apart from when subject to protocol. The present paper put forward elements behind this form of miscommunication and presents results indicating that the major contributing factor is the VTSOs' anticipation of negative attitudes between working groups participating in the VTS system and the lack of sufficient regulation with regard to the role and responsibilities of VTSOs.

Cistectomía radical laparoendoscópica con neovejiga íleal ortotópica a través de puerto único umbilical

ContextRadical cystectomy with orthotopic derivation is one of the most complex urological techniques, although laparoscopic surgery has made this procedure increasingly less invasive. ObjectiveTo provide an up-dated review of the single port approach to carry out radical surgery due to bladder cancer. Evidence AcquisitionA comprehensive review of the literature was performed using Medline and Embase to discover the accumulated experience of the viability of carrying out laparoendoscopic radical cystectomy, pelvic lymphadenectomy and orthotopic neobladder using the laparoendoscopic single site surgery (LESS) approach. Our experience with this approach is also presented and the technique used with the reusable KeyPort® system developed by Richard Wolf is described. Evidence SynthesisRadical treatment of bladder cancer is possible in men and women using a single port and even performance of ileal neobladder, as reconstructive procedure in these patients. The surgical technique, post-operative cares and result obtained in our center are described. The accumulated experience worldwide describes 25 cases of radical cystectomy performed using different single port systems, 14 of them with orthotopic intestinal neobladder. ConclusionThe KeyPort® umbilical cystectomy constitutes in our setting the least possible invasive alternative to efficiently treat muscle-invasive bladder cancer, with excellent esthetic result, minimum post-operative pain and short hospital stay. The umbilical scar decreases the analgesic requirements and it ends up being practically invisible. This supposes an important step in the development of the minimally invasive surgery for bladder cancer.

Single-Port Transumbilical Laparoscopic Appendectomy: A Preliminary Multicentric Comparative Study in 87 Patients with Acute Appendicitis

Introduction. Laparoscopic appendectomy (LA) has been performed in many approaches such as open, laparoscopic and recently Single Port Access (SPAA). In order to elucidate its potential advantages, we compared the two laparoscopic approaches. Methods. 87 patients were included in a multicentric study for suspected appendicitis in order to perform (SPAA) appendectomy or laparoscopic appendectomy (LA). All outcomes, including blood loss, operative time, complications, and length of stay and pain were recorded prospectively. Results. There were 46 patients in the SPAA group and 41 in the LAG with a mean operative time of 40,4 minutes in the SPAA group and 35,0 minutes in the LA group. Only one patient was converted to an open approach. We described only 2 complications. Pain was graded 2,8 in the SPAA group and 2,9 in the LA group, according to the AVS after 24 hours. Patients in the SPAA Group were more satisfied (7,5 versus 6,9) (P < 0.05). Same results were found for the cosmetic result (8,6 versus 7,4) (P < 0.05). Conclusion. Using the single port approach feasible and safe. The true benefit of the technique should be assessed by new randomised controlled trials.

Single Port Approach to Complex Dissection of Residual Ovary

Single port access for laparoscopic surgery is currently used for such indications as prophylactic oophorectomy, hysterectomy, and appendectomy. We present a case of pelvic pain with residual ovarian disease that demonstrates how single port access can be successfully used to approach this clinical problem. The video demonstrates instrumentation and techniques of tissue handling and pelvic sidewall dissection.

Nueva técnica para la ureterectomía distal y excisión de manguito vesical

Introduction We describe a novel endoscopic approach and provide a literature review for the “en bloc” dissection of the distal ureter and bladder cuff during laparoscopic radical nephroureterectomy using a transvesical single port approach under pneumovesicum. Materials and methods The procedure was performed in an 80-year old male with a history of gross hematuria due to left renal pelvic TCC and no history of prior bladder TCC. Laparoscopic radical nephroureterectomy was performed and the ureter was dissected down to the bladder and clipped. A single-port device was inserted transvesically and pneumovesicum established. A full thickness incision of the bladder around the ureter was performed with progressive intravesical mobilization of the distal ureter. Subsequently, a water-tight closure of the bladder defect was achieved. The distal ureter, together with the bladder cuff, was then delivered en bloc laparoscopically with the specimen. Results The operating time (LESS radical nephroureterectomy, RPLND, and bladder cuff excision) was 6 hours and 15 minutes. The bladder cuff time was 45 minutes. There were no intra or postoperative complications and the catheter was removed after 6 days. Histopathological analysis showed kidney-invasive papillary urothelial cancer, pT3 pN0 (0/7) G3. Conclusion The distal ureter and bladder cuff techniques have not yet been standardized. Management of the bladder cuff with a single port is feasible. Additional studies are needed to identify the best approach for management of the distal ureter at the time of laparoscopic nephroureterectomy.

Robotic assisted laparoscopic treatment of gonadal vein syndrome in a boy

Gonadal vein syndrome, with ureteral obstruction and compression by an overlying testicular vein is a controversial and rare diagnosis. Open, laparoscopic, and robot-assisted laparoscopic repairs have been described. We report the first case of robot-assisted gonadal vein ligation for treatment of gonadal vein syndrome in a nine year-old boy. A 9 years-old boy presented with a four to six month history of worsening intermittent flank pain, nausea and vomiting. Ultrasound revealed moderate hydronephrosis. Diuretic renography and intravenous pyelography reproduced his pain and demonstrated left-sided hydronephrosis and obstruction. The patient underwent left robot-assisted surgery via a four port approach. The colon was reflected medially. The gonadal vein was dissected off the underlying ureter and ligated using laparoscopic clips. Segmental vein excision and ureterolysis was performed. Inspection of the renal hilum did not reveal any other crossing vessels. Operative time was 94 minutes. The patient was discharged 36 hours after surgery. His hydronephrosis has resolved completely. He remains pain-free nine months after surgery. Robot-assisted laparoscopic vein excision and ureterolysis is a safe option for the management of ureteral obstruction caused by the gonadal vein.

Parasitic myoma in mesentery mimicking gastrointestinal stromal tumor: A case of laparoscopic myomectomy with single port approach

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor in the gastrointestinal tract, and express a highly specifi c marker called c-kit (CD117). The majorinty of GISTs arise in the stomach (60%) and small bowel (30%), and remaining 10% in the other gastrointestinal tract. It also occurs, rarely, in non-gastrointestinal tract. We experienced a 42-year-old woman who was transferred to our hospital with the impression of GIST by positron emission tomography-computed tomography, and after the single port approach laparoscopy, fi diagnosed as parasitic myoma. Hysterectomy and complete resection of 14cm sized mesenteric mass was done via single port laparoscopy. After the immunohistochemistry test, the fi pathologic diagnosis was confi rmed the diagnosis of myoma. We report here the case of parasitic myoma mimicking GIST with brief review of articles.

A novel technique for distal ureterectomy and bladder cuff excision

IntroductionWe describe a novel endoscopic approach and provide a literature review for the “en bloc” dissection of the distal ureter and bladder cuff during laparoscopic radical nephroureterectomy using a transvesical single port approach under pneumovesicum. Materials and methodsThe procedure was performed in an 80-year old male with a history of gross hematuria due to left renal pelvic TCC and no history of prior bladder TCC. Laparoscopic radical nephroureterectomy was performed and the ureter was dissected down to the bladder and clipped. A single-port device was inserted transvesically and pneumovesicum established. A full thickness incision of the bladder around the ureter was performed with progressive intravesical mobilization of the distal ureter. Subsequently, a water-tight closure of the bladder defect was achieved. The distal ureter, together with the bladder cuff, was then delivered en bloc laparoscopically with the specimen. ResultsThe operating time (LESS radical nephroureterectomy, RPLND, and bladder cuff excision) was 6hours and 15minutes. The bladder cuff time was 45minutes. There were no intra or postoperative complications and the catheter was removed after 6 days. Histopathological analysis showed kidney-invasive papillary urothelial cancer, pT3 pN0 (0/7) G3. ConclusionThe distal ureter and bladder cuff techniques have not yet been standardized. Management of the bladder cuff with a single port is feasible. Additional studies are needed to identify the best approach for management of the distal ureter at the time of laparoscopic nephroureterectomy.