Single-port Access Device Research Articles

Reduced-port surgery with the cowboy technique for a gastric submucosal tumor.

Laparoscopic surgery is considered safe and effective for a gastric submucosal tumors, and reduced-port surgery (RPS) is being increasingly performed to treat these tumors. Herein, we present laparoscopic RPS with the cowboy technique for the removal of gastric submucosal tumors. A single-port access device was inserted at the naval (three 5-mm trocars), and a 5-mm trocar was inserted in the left lateral abdominal wall. A ligature was placed at the neck of the tumor, the loop was then tightened, and the knot was finally secured-a process referred to as the cowboy technique. This technique enables complete surgical excision and can be used for exophytic submucosal tumors of the stomach. Four patients underwent RPS with this technique, and the outcomes were good. Our cowboy technique enables the safe full-thickness excision of gastric submucosal tumors with exophytic growth and is very useful in performing RPS.

Laparoendoscopic Single Site Myomectomy: Without the Use of a Single Port Access Device

Objective: Herein we described our experience with laparoendoscopic single site mymectomy (LESS-M) without the use of a single port access device and compared the clinical outcomes between LESS-M and conventional laparoscopic mymectomy (LM). Methods: From January 2012 to December 2014, 32 patients with leiomyomas underwent LESS-M in our hospital were enrolled in this prospective observational case-control study, and were 1:1 matched and compared with 32 patients who underwent LM by the same operative team for leimyomas of similar size and location. Patients and surgical data, and follow-up information were analyzed. Results: The operating time in the LESS-M group was significantly longer than that in the LM group (98 ± 9 min vs 56 ± 7 min, P=0.000), but the patients returned to work significantly earlier (2.9 ± 0.5 week vs 3.7 ± 1.1, P=0.001), and the cosmetic satisfaction score was significantly higher (9.3 ± 0.6 vs 8.4 ± 0.7, P=0.000). There was no significant difference of the mean intraoperative blood loss, hemoglobin change, return of bowel activity, postoperative fever, operation cost and total cost between the two groups. Conclusion: LESS-M is a feasible, safe, and efficacious procedure with shorter recovery and increased cosmetic satisfaction in selected patients with leiomyoma, and it can be cost-effectively performed without the need for a single port access device.

Single-port laparoscopic cryptorchidectomy in dogs and cats: 25 cases (2009-2014).

To describe the operative technique for single-port laparoscopic cryptorchidectomy (SPLC) in dogs and cats and evaluate clinical outcome for patients that underwent the procedure. Retrospective case series. 25 client-owned dogs (n = 22) and cats (3). Dogs and cats that underwent SPLC with 3 commercially available single-port devices between 2009 and 2014 were retrospectively identified through a multi-institutional medical records review. Surgery was performed via a single-port device placed through a 1.5- to 3.0-cm abdominal incision either at the region of the umbilicus or caudal to the right 13th rib. The cryptorchidectomy was performed with graspers, a bipolar vessel sealing device, and a 30° telescope. SPLC was performed with a single-incision laparoscopic surgery port (n = 15), a multitrocar wound-retractor access system (8), or a metal resterilizable single-port access device (2). Median age was 365 days (range, 166 to 3,285 days). Median body weight was 18.9 kg (41.6 lb; range, 1.3 to 70 kg [2.9 to 154 lb]). Median surgical time was 38 minutes (range, 15 to 70 minutes). Thirty-two testes were removed (12 left, 6 right, and 7 bilateral). Four patients had 1 additional abdominal surgical procedure performed concurrently during SPLC. No intraoperative or postoperative complications were encountered. Results suggested that SPLC can be performed in a wide range of dogs and cats with cryptorchidism and can be combined with other elective laparoscopic surgical procedures. The SPLC technique was associated with a low morbidity rate and provided a potentially less invasive alternative to traditional open and multiport laparoscopic techniques.

Single-Port Laparoscopic Approach of the Left Liver: Initial Experience

IntroductionNew technological advances have enabled the development of single-port laparoscopic surgery. This approach began with cholecystectomy and subsequently with other abdominal surgeries. However, few publications on laparoscopic liver surgery have described the use of complete single-port access. We present our initial experience of a single-port laparoscopic hepatectomy. Materials and methodsBetween May 2012 and December 2013, 5 single-port laparoscopic hepatectomies were performed: 1 for benign disease and 4 for colorectal liver metastases. The lesions were approached through a 3–5cm right supraumbilical incision using a single-port access device. All the lesions were located in hepatic segments II or III. Four left lateral sectorectomies and 1 left hepatectomy were performed. ResultsMedian operative time was 135min. No cases were converted to conventional laparoscopic or open surgery. The oral intake began at 18h. There were no postoperative complications and no patients required blood transfusion. The median hospital stay was 3 days. The degree of satisfaction was very good in 4 cases and good in 1. Patients resumed their normal daily activities at 8 days. DiscussionSingle-port laparoscopic hepatectomy is safe and feasible in selected cases and may reduce surgical aggression and offer better cosmetic results. Comparative studies are needed to determine the real advantages of this approach.

A novel single twist-drill access device for multimodal intracranial monitoring: a 5-year single-institution experience.

Multimodal intracranial monitoring in the neurosurgical patient requires insertion of probes through multiple craniostomies. To report our 5-year experience with a novel device allowing multimodal monitoring though a single twist-drill hole. All devices (Hummingbird Synergy, Innerspace) were placed at the Kocher point between 2008 and 2013 at our institution. An independent clinical research nurse prospectively collected data on all bedside placements. Placement accuracy was graded on computed tomography scan as grade 1 (ipsilateral frontal horn or third ventricle), grade 2 (contralateral lateral ventricle), and grade 3 (anywhere else). Infection was monitored with serial cerebrospinal fluid samples. Two hundred seventy-five devices (198 at bedside, 77 in operating room) were placed in patients with spontaneous subarachnoid hemorrhage (49%), traumatic brain injury (47%), and others (4%) for a median duration of 6 days. A junior (postgraduate year 1-2), midlevel (postgraduate year 3-4), or senior resident (postgraduate year 5-6) placed 39%, 32%, and 29% of the devices, respectively. Ninety-two percent of all devices placed were draining cerebrospinal fluid, ie, were grade 1 (75%) or 2 (17%). Placement accuracy did not vary with level of training. Complications included hemorrhage (10%) and infection (4%), with 1 patient requiring intraparenchymal hematoma evacuation and a second requiring abscess drainage. These rates were lower than reported in the literature for standard external ventricular drains. Hummingbird Synergy is a novel single-port access device for multimodal intracranial monitoring that can be placed safely at the bedside or in the operating room with placement accuracy and has a complication profile similar to or better than that for standard external ventricular drains.

Single‐incision laparoscopic ileorectal anastomosis

Minimally invasive approaches for stoma closure offer considerable benefits for patients. Single port access via an end ileostomy site after stoma take-down in patients with prior total colectomy and a rectal stump remnant could allow restoration of ileorectal continuity by anastomosis but has not been detailed previously. After mobilisation of the end ileostomy, the anvil of a circular stapler is secured into the open end of the distal ileum and the intestine returned into the abdominal cavity. A single port access device (in this description, a 'surgical glove port') is placed then into the stoma site and full laparoscopy performed. Once the rectal stump is identified and prepared, an intracorporeal anastomosis can be constructed in a tension-free manner using a Knight-Griffin technique. Leak-testing can also be performed and the operation concluded with closure of the solitary incision. In selected cases, adhesiolysis and anastomosis can be safely performed in toto. If the peritoneal environment is challenging, access can be escalated to multiport laparoscopy or even laparotomy. Initiation of ileorectal anastomosis construction by single port laparoscopy at least allows peritoneal assessment but can provide for the operation's completion. This can confer maximum patient benefit for the most minimally invasive option.

Abordaje laparoscópico por incisión única del hígado izquierdo: experiencia inicial

IntroductionNew technological advances have enabled the development of single-port laparoscopic surgery. This approach began with cholecystectomy and subsequently with other abdominal surgeries. However, few publications on laparoscopic liver surgery have described the use of complete single-port access. We present our initial experience of a single-port laparoscopic hepatectomy. Material and methodsBetween May 2012 and December 2013, 5 single-port laparoscopic hepatectomies were performed: one for benign disease and four for colorectal liver metastases. The lesions were approached through a 3-5cm right supraumbilical incision using a single-port access device. All the lesions were located in hepatic segments II or III. Four left lateral sectorectomies and one left hepatectomy were performed. ResultsMedian operative time was 135min. No cases were converted to conventional laparoscopic or open surgery. The oral intake began at 18h. There were no postoperative complications and no patients required blood transfusion. The median hospital stay was 3 days. The degree of satisfaction was very good in 4 cases and good in one. Patients resumed their normal daily activities at 8 days. DiscussionSingle-port laparoscopic hepatectomy is safe and feasible in selected cases and may reduce surgical aggression and offer better cosmetic results. Comparative studies are needed to determine the real advantages of this approach.

Single-incision laparoscopic sleeve gastrectomy: initial experience in 20 patients and 2-year follow-up

SummaryBackgroundThe transumbilical route began being clinically feasible with or without unique access devices.SettingThe setting for this study was a private practice at Clínica Las Condes, Santiago, Chile.ObjectiveThe objective was to describe our experience performing a laparoscopic sleeve gastrectomy (LSG) via transumbilical route using a single-port access device in addition to standard laparoscopic instruments.MethodA prospective nonrandomized protocol was applied to patients fulfilling the following inclusion criteria: to have been medically indicated for an LSG, to have a body mass index (BMI) of less than or equal to 40 kg/m2, and the distance between the xiphoid appendix and umbilicus should be less than 22 cm. All patients were female with a median (p50) age of 34.5 (ranging from 21 to 57) years, a median weight of 92 (ranging from 82.5 to 113) kg, and a median BMI of 35.1 (ranging from 30.5 to 40) kg/m2. The device insertion technique, the gastrectomy, and postoperative management are described.ResultsLSG via transumbilical route was successfully carried out in 19 of the 20 patients in whom the procedure was performed; one patient had to be converted to a conventional laparoscopic procedure. Mean operating time was 127 (ranging from 90 to 170) min. On the second postoperative day, all patients were assessed through an upper gastrointestinal barium-contrasted radiological series. There was neither morbidity nor mortality in this group. Excess weight loss at 25 months after surgery was 114 %.ConclusionsSingle-port LSG can be successfully performed in selected obese patients with a BMI of less than 40 kg/m2 using traditional laparoscopic instruments. The technique allows performing a safe and effective vertical gastrectomy.

Reusable single-port access device shortens operative time and reduces operative costs

In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy. We performed 22 laparoscopic procedures via the SPL approach using a reusable single-port access system and reusable laparoscopic instruments. These included 17 cholecystectomies and five other procedures. Operative time, postoperative length of stay (LOS) and complications were prospectively recorded and were compared with similar data from our SPL database. Student's t test was used for statistical analysis. SPL was successfully performed in all cases. Mean operative time for cholecystectomy was 72 min (range 40-116). Postoperative LOS was not changed from our standard protocols and was 1.1 days for cholecystectomy. The postoperative course was within normal limits for all patients and perioperative morbidity was recorded. Both operative time and length of hospital stay were shorter for the 17 patients who underwent cholecystectomy using a reusable port than for the matched previous 17 SPL cholecystectomies we performed (p < 0.001). Prices of disposable SPL instruments and multiport access devices as well as extraction bags from different manufacturers were used to calculate the cost difference. Operating with a reusable port ended up with an average cost savings of US$388 compared with using disposable ports, and US$240 compared with standard laparoscopy. Single-port laparoscopic surgery is a technically challenging and expensive surgical approach. Financial concerns among others have been advocated against this approach; however, we demonstrate herein that using a reusable port and instruments reduces operative time and overall operative costs, even beyond the cost of standard laparoscopy.

Laparoendoscopic Single-site Radical Hysterectomy With Pelvic Lymphadenectomy: Initial Multi-institutional Experience for Treatment of Invasive Cervical Cancer

Study ObjectiveTo describe the feasibility, safety, and outcomes of women with stage I cervical cancer treated with laparoendoscopic single-site surgery radical hysterectomy (LESS-RH). DesignA retrospective descriptive study (Canadian Task Force classification III). SettingMultiple academic teaching hospitals. PatientsWomen with Fédération Internationale de Gynécologie et d'Obstétrique FIGO stage IA1 to IB1 cervical cancer. InterventionsLESS-RH as the primary therapy for cervical cancer performed by a gynecologic oncologist with expertise in LESS. A multichannel, single-port access device; a flexible-tipped 5-mm laparoscope; and a multifunctional instrument were used in all cases. Clinicopathologic, surgical, and perioperative outcomes were analyzed. Measurements and Main ResultsTwenty-two women were identified in whom a LESS-RH was attempted; 20 (91%) successfully underwent the procedure, including 19 in whom pelvic lymphadenectomy (PLND) was completed. Of the 2 converted procedures, 1 patient underwent 2-port laparoscopy secondary to truncal obesity, and 1 patient underwent conversion to laparotomy secondary to external iliac vein laceration during PLND. The median age and body mass index were 46 years and 23.3 kg/m2, respectively. The median number of pelvic lymph nodes removed was 22. One patient experienced an intraoperative complication, and no patient required reoperation. The margins of excision were negative. One patient with 2 positive pelvic nodes and 1 patient with microscopic parametrial disease received adjuvant chemosensitized radiation; 3 additional patients received adjuvant radiation therapy secondary to an intermediate risk for recurrence. After a median follow up of 11 months, no recurrences were detected. ConclusionLESS-RH/PLND is feasible and safe for select patients with stage I cervical cancer. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice.

Trans-umbilical laparo-endoscopic single-site donor nephrectomy without the use of a single-port access device

Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a procedure in evolution. Currently described techniques utilize single port access devices and articulating, flexible, and bent working instruments. We describe a modified technique of transumbilical LESS-DN with conventional laparoscopic instruments in five kidney donors.Three standard laparoscopic ports (10 mm × 1, 5 mm × 2) were placed through a 4.5 cm vertical transumbilical incision. A 10 mm 45°, long bariatric lens (Karl Storz) was used. Renal mobilization was performed using conventional rigid laparoscopy instruments. A port closure needle loaded with a blunt plastic needle cap was used for traction. After hilar clamping, an incision was made connecting the three ports, and the kidney was extracted using a preplaced suture over the lower pole fat. All data were prospectively recorded.LESS-DN was performed successfully in all five patients. The mean operative time was 157.2 minutes (range, 134-184) and the mean warm ischemia time was 3.2 minutes (range, 3-4). All donors were discharged on postoperative day 3 and were able to resume normal physical activity by 2 weeks after the procedure. All donors had an excellent cosmetic outcome. The mean serum creatinine (recipient) at discharge was 1.14 mg% (range, 0.9-1.4).Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.

Single-Incision Laparoscopic Sigmoid Resection

Initially described in 2008, single-incision laparoscopic colectomy has evolved into a safe and feasible surgical approach. Noted advantages include elimination of trocar-site incisions and improved cosmesis. Additional benefits including reduced abdominal wall trauma, diminished pain, and shorter length of hospitalization have been proposed. Following utilization in over 150 colectomies, we present a standardized approach and describe our technique for single-incision laparoscopic sigmoid resection through a single-port access device. A 2.5-cm umbilical incision is used for insertion of the single-incision access device. A 30° 5-mm camera with a right-angle light cord adaptor and 2 bowel graspers are inserted through the access device. Exploration and lysis of adhesions are performed before placing the patient in a steep Trendelenburg position with 20° left-sided elevation. Dissection commences in a medial-to-lateral fashion, developing the presacral avascular plane while ensuring nerve preservation. The retroperitoneal plane is established from the sacral promontory to the lateral peritoneal reflection. After identification of the left ureter and isolation of the vascular pedicle, the inferior mesenteric artery is isolated and ligated. The lateral attachments of the left colon and rectosigmoid are then divided, followed by additional pelvic dissection along the presacral avascular plane. The mesentery of the distal resection margin is divided before transection of the corresponding bowel using a stapling device. The bowel is then extracted and resected at the site of the single-incision access device. An intracorporeal primary end-to-end anastomosis is fashioned. We present a dynamic article with video illustrating a standardized medial-to-lateral approach for single-incision laparoscopic sigmoid resection. The technique effectively avoids the use of multiple trocar sites, maintains basic oncologic principles of resection, and affords the benefits of minimally invasive surgery.

Single port-assisted fully laparoscopic abdominoperineal resection (APR) with immediate V-RAM flap reconstruction of the perineal defect

Abdominoperineal resection (APR) of anorectal cancers after neoadjuvant chemoradiotherapy may incur significant perineal morbidity. While vertical rectus abdominis muscle (V-RAM) flaps can fill the pelvic resection space with health tissue, their use has previously been described predominantly in association with laparotomy. Here, we describe a means of combination laparoscopic APR with V-RAM flap reconstruction that allows structural preservation of the entire abdominal wall throughout the oncological resection and of the deep parietal layers after V-RAM donation. Furthermore, a single port access device used at the end colostomy site allows a second senior surgeon assist with an additional two working instruments for the purpose of improved pelvic tissue retraction, especially useful in obese patients.

Single-port laparoscopic hepatectomy: technique, safety, and feasibility in a clinical case series

The recent use of single-port-access surgery in cholecystectomy and other abdominal surgeries has confirmed its safety and validity as a treatment option. However, few reports have described the use of complete single-port access surgeries in hepatectomy for neoplasms. The authors performed single-port laparoscopic hepatectomy (SLH) for eight patients (5 patients with hepatocellular carcinoma, 1 patient with metastatic liver tumor, 1 patient with endocrine liver tumor, and 1 patient with hemangioma). Furthermore, in terms of Child-Pugh classification, five patients were in category A, two in category B, and one in category C. The patients were eligible for SLH if they had solitary tumors measuring 3 cm or smaller on the caudal surface of the liver. The lesion was approached through a 20-mm supraumbilical incision using a single-port access device. No patient experienced intraoperative complications that required additional port access and conversion to laparotomy. The operative time was 148 min (range, 141-235 min). The postoperative course of the patients was uneventful, and they were discharged an average of 6.2 days (range, 3-11 days) after the operation. Approximately 2 weeks after discharge, the patients experienced no wound pain or liver dysfunction. The SLH technique is a safe and feasible procedure for a specific group of candidates, including patients with high-grade liver dysfunction.

Transanal single port access to facilitate distal rectal mobilization in laparoscopic rectal sleeve resection with hand-sewn coloanal anastomosis

Laparoscopic rectal sleeve resection is challenging and technically demanding. Exposure and mobilization of the most distal part of the rectum can be especially hazardous. We propose the use of a single port access device, placed in the anal canal after incision of the sleeve at the appropriate level, to facilitate dissection without sphincter damage. The case of a 51-year-old woman suffering from a recurrent supralevator abscess is presented to illustrate the technique. The procedure consisted of laparoscopic rectal pull-through with rectal sleeve resection and coloanal anastomosis. Incision of the endopelvic fascia and mobilization of the distal mesorectum was performed via the single port device under direct control. Medial-to-lateral mobilization of the colon was performed with a 3-port technique. Total operating time was 122 min: 50 min for rectal mobilization, 42 min for the laparoscopic part of the procedure and 30 min for the coloanal anastomosis. The patient's recovery was uneventful, and at 1-month follow-up, she was asymptomatic. Laparoscopic-assisted transanal single port rectal mobilization seems to be a promising addition to the armamentarium of minimally invasive surgery.

Trocar-Site Hernia After Single-Port Cholecystectomy: Not an Exceptional Complication?

When compared with standard multiport laparoscopy, the larger fascial incision in single-port surgery (SPS) may imply a potentially increased risk of surgical-site complications, such as herniation. The long-term risk of access-site complications in SPS is still unpredictable. Between July 2009 and May 2011, n=78 patients (n=54 females), with a median age of 42 years (range: 18-85 years), underwent single-port cholecystectomy. The median body mass index was 25.4 kg/m(2) (range: 17-39 kg/m(2)). All surgeries were performed by a single surgeon (K.K.) using a completely reusable single-port access device (X-Cone™; KARL STORZ GmbH, Tuttlingen, Germany), and fascial closure technique was comparable in all patients. The first 50 patients (n=32 females) attended a structured follow-up examination including a meticulous clinical examination and ultrasonography of the access site at a median follow-up time of 17 months (range: 9-23 months). We recorded postoperative complications in 5 of the 50 patients (10%) after single-port cholecystectomy. Four occurred in the early postoperative course and presented as mild wound complications. One of the 50 patients (2%) experienced a symptomatic trocar-site hernia (TSH) 4 months after surgery. No biliary complications (bile leakage, retained stones, etc.) were recorded. Although potentially biased by a relatively small number of patients, our study provides evidence that TSH after single-port cholecystectomy is (i) not less frequent when compared with standard laparoscopy, (ii) not as infrequent as suggested by the current literature, and (iii) not only associated with technical failure or patients' comorbidity.

Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach

Minimally invasive surgery is advancing with single port access (SPA). We describe a technique for a SPA transabdominal combined with transanal approach to perform laparoscopic proctectomy with total mesorectal excision (TME) and intersphincteric resection of low rectal adenocarcinoma. Transanal intersphincteric resection was followed by laparoscopic abdominal proctectomy with TME. An SPA device was placed at the site of the future stoma through a 2.5-cm incision. A hand-sewn side-to-end coloanal anastomosis was performed and a terminal loop ileostomy was created at the site of the SPA device. The procedure was performed on two healthy nonobese women who had not had previous abdominal surgery. The operating times were 195 and 210 min, and blood loss < 250 ml. The postoperative course was uneventful, with discharge on postoperative days 5 and 6. Pathological examination revealed adequate surgical margins and lymph node retrieval with an intact mesorectum. Four weeks after stoma closure, the scar in the right lower quadrant was 35 mm in one patient and 45 mm in the other, and the scar from the 5-mm port was barely visible. This preliminary experience shows that proctectomy with TME and intersphincteric resection can be safely performed using only two ports.

V1227 ATHERMAL NERVE-SPARING ROBOTIC LAPAROENDOSCOPIC SINGLE-SITE RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Oncology1 Apr 2011V1227 ATHERMAL NERVE-SPARING ROBOTIC LAPAROENDOSCOPIC SINGLE-SITE RADICAL PROSTATECTOMY Michael A. White, Riccardo Autorino, Gregory Spana, Rakesh Khanna, Shahab Hillyer, Bo Yang, Humberto Laydner, Fatih Altunrende, Wahib Isac, Robert J. Stein, Georges-Pascal Haber, and Jihad H. Kaouk Michael A. WhiteMichael A. White Cleveland, OH More articles by this author , Riccardo AutorinoRiccardo Autorino Cleveland, OH More articles by this author , Gregory SpanaGregory Spana Cleveland, OH More articles by this author , Rakesh KhannaRakesh Khanna Cleveland, OH More articles by this author , Shahab HillyerShahab Hillyer Cleveland, OH More articles by this author , Bo YangBo Yang Cleveland, OH More articles by this author , Humberto LaydnerHumberto Laydner Cleveland, OH More articles by this author , Fatih AltunrendeFatih Altunrende Cleveland, OH More articles by this author , Wahib IsacWahib Isac Cleveland, OH More articles by this author , Robert J. SteinRobert J. Stein Cleveland, OH More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber Cleveland, OH More articles by this author , and Jihad H. KaoukJihad H. Kaouk Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.885AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic Single-Site Surgery(LESS) is challenging and fraught with ergonomic obstacles. Implementation of the Da Vinci robot to LESS (R-LESS) has diminished many of these obstacles and expanded it's surgical application to include complex cases such as nerve-sparing radical prostatectomy. We present our experience with athermal nerve-sparing R-LESS radical prostatectomy and describe our technique. METHODS Between May 2008 and May 2010. A total of 20 R-LESS radical prostatectomies were performed, including 3 using an athermal nerve-sparing technique. We demonstrate the steps of this procedure in video format including: 1) Placement of the single port access device, 2) Description of necessary equipment 3) Mobilization of the bladder 4) Incision of the endopelvic fascia 5) Ligation of the dorsal venous complex 6) Dissection of the bladder neck 7) Dissection of the seminal vesicles 8) Control of the vascular pedicles 9) Antegrade dissection of the neurovascular bundles from the prostate, 10) Antegrade dissection of the prostate from the rectum 11) Transection of the dorsal venous complex and urethra 12) Entrapment of the prostate, and 13) Vesico-urethral anastamosis. Additionally we present our cumulative outcomes including: demographics, perioperative data, pathology, margin status, postoperative SHIM score, and continence rates. RESULTS All three athermal nerve-sparing R-LESS radical prostatectomies were performed without the addition of extra ports. Demographics and postoperative outcomes are seen in the table. The mean operative time was 170 minutes and estimated blood loss was 100ml. Visual analogue pain scale scores was 1/10. Mean follow up was 6 months. CONCLUSIONS Robotic laparoendoscopic single-site surgery continues to evolve and with refinements, complex procedures such as athermal nerve-sparing radical prostatectomy are possible. Our early results are promising but prospective comparisons to standard nerve-sparing RALP are needed. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e491-e492 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael A. White Cleveland, OH More articles by this author Riccardo Autorino Cleveland, OH More articles by this author Gregory Spana Cleveland, OH More articles by this author Rakesh Khanna Cleveland, OH More articles by this author Shahab Hillyer Cleveland, OH More articles by this author Bo Yang Cleveland, OH More articles by this author Humberto Laydner Cleveland, OH More articles by this author Fatih Altunrende Cleveland, OH More articles by this author Wahib Isac Cleveland, OH More articles by this author Robert J. Stein Cleveland, OH More articles by this author Georges-Pascal Haber Cleveland, OH More articles by this author Jihad H. Kaouk Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V1228 BEHIND THE STAGE: LAPAROSCOPIC VIEW OF RETROPUBIC AREA DURING RADICAL PERINEAL PROSTATECTOMY

cation to include complex cases such as nerve-sparing radical prostatectomy. We present our experience with athermal nerve-sparing RLESS radical prostatectomy and describe our technique. METHODS: Between May 2008 and May 2010. A total of 20 R-LESS radical prostatectomies were performed, including 3 using an athermal nerve-sparing technique. We demonstrate the steps of this procedure in video format including: 1) Placement of the single port access device, 2) Description of necessary equipment 3) Mobilization of the bladder 4) Incision of the endopelvic fascia 5) Ligation of the dorsal venous complex 6) Dissection of the bladder neck 7) Dissection of the seminal vesicles 8) Control of the vascular pedicles 9) Antegrade dissection of the neurovascular bundles from the prostate, 10) Antegrade dissection of the prostate from the rectum 11) Transection of the dorsal venous complex and urethra 12) Entrapment of the prostate, and 13) Vesico-urethral anastamosis. Additionally we present our cumulative outcomes including: demographics, perioperative data, pathology, margin status, postoperative SHIM score, and continence rates. RESULTS: All three athermal nerve-sparing R-LESS radical prostatectomies were performed without the addition of extra ports. Demographics and postoperative outcomes are seen in the table. The mean operative time was 170 minutes and estimated blood loss was 100ml. Visual analogue pain scale scores was 1/10. Mean follow up was 6 months. CONCLUSIONS: Robotic laparoendoscopic single-site surgery continues to evolve and with refinements, complex procedures such as athermal nerve-sparing radical prostatectomy are possible. Our early results are promising but prospective comparisons to standard nervesparing RALP are needed.

Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device

Introduction:Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a procedure in evolution. Currently described techniques utilize single port access devices and articulating, flexible, and bent working instruments. We describe a modified technique of transumbilical LESS-DN with conventional laparoscopic instruments in five kidney donors.Materials and Methods:Three standard laparoscopic ports (10 mm × 1, 5 mm × 2) were placed through a 4.5 cm vertical transumbilical incision. A 10 mm 45°, long bariatric lens (Karl Storz) was used. Renal mobilization was performed using conventional rigid laparoscopy instruments. A port closure needle loaded with a blunt plastic needle cap was used for traction. After hilar clamping, an incision was made connecting the three ports, and the kidney was extracted using a preplaced suture over the lower pole fat. All data were prospectively recorded.Results:LESS-DN was performed successfully in all five patients. The mean operative time was 157.2 minutes (range, 134–184) and the mean warm ischemia time was 3.2 minutes (range, 3–4). All donors were discharged on postoperative day 3 and were able to resume normal physical activity by 2 weeks after the procedure. All donors had an excellent cosmetic outcome. The mean serum creatinine (recipient) at discharge was 1.14 mg% (range, 0.9–1.4).Conclusions:Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.