Transumbilical Laparoendoscopic Single-site Surgery Research Articles

Comparison of hysterectomy cases performed by transvaginal natural orifice transluminal endoscopic surgery: A paired sample cross-sectional study.

This study aimed to investigate the feasibility, indications, and benefits of transvaginal natural orifice transluminal endoscopic surgery (v-NOTES) hysterectomy for nonmalignant gynecological diseases. The clinical data, including the baseline information and surgical conditions of 81 patients who underwent v-NOTES hysterectomy for nonmalignant gynecological diseases in a tertiary university hospital from October 2018 to August 2022, were retrospectively analyzed and compared with the total laparoscopic hysterectomy group (200 cases) and the transumbilical laparoendoscopic Single Site Surgery group (150 cases). In comparison with the other 2 groups, the highest proportion of patients in the v-NOTES group had cervical intraepithelial neoplasia. Accordingly, mean preoperative uterine volume measured by sonography was significantly smaller in the v-notes group. In the v-NOTES group, the mean number of vaginal deliveries and age were significantly higher, while the mean number of previous abdominal surgeries was lower compared to the other 2 groups. The V-NOTES group had a shorter operation time, shorter postoperative urinary catheter insertion time, earlier intestinal recovery days, shorter hospital stay, and lower visual analogue scale scores after surgery, and the differences were statistically significant. When indicated appropriately, v-NOTES hysterectomy can be a feasible and advantageous surgical modality. In particular, in comparison to the laparoendoscopic Single Site Surgery and total laparoscopic hysterectomy groups, the v-NOTES group had advantages in postoperative recovery and had more aesthetic surgical results.

Assessing the learning curve for transumbilical single-site laparoscopy for endometrial cancer.

Applying transumbilical laparoendoscopic single-site surgery to endometrial cancers is worldwide, and the depiction of the learning curve is rarely described, which leads to the vagueness of young clinical practitioners. We accumulated the data to identify the completion of the learning curve by analyzing the operative and postoperative outcomes of the patients with endometrial cancer for transumbilical laparoendoscopic single-site surgery (TU-LESS). This was a retrospective, consecutive single-center study of patients with endometrial cancer undergoing standard endometrial cancer comprehensive staging surgery (extrafascial hysterectomy, bilateral salpingectomy, and pelvic lymphadenectomy) through TU-LESS by an experienced surgeon from December, 2017 to June, 2021 in the Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, China. After applying the inclusion and exclusion criteria, 42 patients were included in the study. The learning curve for this study was evaluated using both cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. Applying CUSUM and RA-CUSUM has grouped 42 cases into three phases. The prior five cases represented the learning period. The following six cases were needed to lay a technical foundation (cases 6-11). The third phase was regarded as achieving proficiency (cases 12-42). The operative time decreased drastically with the learning curve. There were no significant differences in terms of postoperative complications and lymph node retrieval among the three phases. More difficult patients were confronted in the third phase. In our study, the learning curve was composed of three phases. According to the results of our study, 11 cases were required for experienced surgeons to achieve a technical foundation.

Comparing the efficacy and safety of three surgical approaches for total hysterectomy (TSATH): protocol for a multicentre, single-blind, parallel-group, randomised controlled trial

IntroductionHysterectomy is the most common surgical procedure in the field of gynaecology. The traditional multiport laparoscopy, transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy...

Transvaginal natural orifice endoscopic surgery for tubal ectopic pregnancy: A more suitable surgical approach for enhanced recovery after surgery

ObjectiveWe aimed to determine the safety of Vaginal natural orifice transluminal endoscopic surgery (vNOTES) in terms of the Enhanced Recovery after Surgery (ERAS) concept for tubal pregnancy surgery and provide a detailed process of vNOTES for tubal pregnancy surgery, including experience and key points for surgeons performing this procedure. MethodsThe Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 219 patients who underwent tubal ectopic pregnancy surgery between September 2021 and March 2022. The patients underwent salpingectomy or salpingostomy using transumbilical laparoendoscopic single-site surgery (LESS) or vNOTES, according to their preferences. This study prospectively collected perioperative and one-year follow-up data on tubal pregnancy outcomes after vNOTES and compared them with those after LESS. ResultsThe vNOTES group showed a shorter surgical duration, hospitalization duration, and postoperative exhaust time and a lower analgesic medication usage rate, but it showed a higher surgical conversion rate. The vNOTES approach reduced the postoperative exhaust time by approximately 9 h (95% confidence interval [CI]: −11.93, −5.57 h, p < .001) and the risk of postoperative analgesic drug use by 77% (odds ratio, 0.23; 95% CI: 0.10, 0.61, p = .023). ConclusionvNOTES can shorten the exhaust time and duration of hospitalization, reduce postoperative pain, and avoid surface surgical scars in tubal pregnancy surgeries, consistent with the ERAS concept. However, more comprehensive preoperative evaluation of patients who choose vNOTES is required to reduce the occurrence of intraoperative conversion.Trial registration: ChiCTR2100053483.

Perioperative outcomes of transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendoscopic single-site surgery in hysterectomy: A comparative study.

This study aimed to compare the perioperative outcomes of patients who underwent hysterectomy for benign gynecologic diseases using transvaginal natural orifice transluminal endoscopic surgery (vNOTES) or transumbilical laparoendoscopic single-site surgery (TU-LESS). A total of 314 patients who underwent hysterectomy for benign uterine disease at West China Second University Hospital between October 2018 and December 2021 were enrolled in this retrospective study. vNOTES (n = 157) and TU-LESS (n = 157) recipients were matched 1:1 in terms of uterine volume. The operation time, blood loss, postoperative decrease in hemoglobin, uterus weight, postoperative hospital stay, postoperative pain score at 12 h, postoperative indwelling catheter time, and other clinical indicators were compared between the two groups. All 314 patients successfully completed the surgery, and the two groups had similar baseline characteristics, with no statistical difference. Regarding intraoperative outcomes, the operation time was shorter in the vNOTES group than in the TU-LESS group (80 vs 100 min, P = 0.04), and there were no significant differences in intraoperative blood loss, intraoperative blood transfusion rate, postoperative decrease in hemoglobin, or uterine weight. Concerning postoperative outcomes, vNOTES hysterectomy was significantly superior to TU-LESS hysterectomy in terms of the length of hospital stay (3 vs 4 days, P < 0.001), visual analog scale score for pain at 12 h after surgery (P = 0.04), postoperative indwelling catheter time (39.5 vs 64.0 h, P < 0.001), and postoperative exhaust time (24.0 vs 42.0 h, P < 0.001). There were no significant differences in postoperative complications between the two groups. vNOTES and TU-LESS seem safe and feasible for hysterectomy, but vNOTES hysterectomy was more conducive to the postoperative rehabilitation of patients, with less trauma, less pain, and better cosmetic effects than TU-LESS hysterectomy. As an emerging surgical approach, more studies, including large-sample, multicenter, randomized controlled trials, are needed to validate our findings.

Efficacy of transumbilical laparoendoscopic single-site surgery versus multi-port laparoscopic surgery for endometrial cancer: a retrospective comparison study.

Although single-port laparoscopy surgery has been evaluated for several years, it has not been widely adopted by gynecologic oncologists. The objective was to compare the perioperative outcomes and survival of endometrial cancer (EC) patients undergoing transumbilical laparoendoscopic single-site surgery (TU-LESS) with multi-port laparoscopic surgery (MLS). This is a retrospective comparative monocentric study including patients treated between December 2017 and October 2021. The perioperative outcomes and survival of EC patients who had surgery via TU-LESS or MLS were compared, by propensity matching. A total of 156 patients were included (TU-LESS vs. MLS: 78 vs. 78). The conversion rate of TU-LESS and MLS was 5.13% and 2.56%, respectively (P=0.681). The operation time was comparable between the two groups [207.5min (180-251) vs. 197.5min (168.8-225), P=0.095]. There was no significant difference between the two groups in exhaustion time, perioperative complications, or postoperative complications. While, the TU-LESS group had a shorter out-of-bed activity time [36 hours (24-48) vs. 48 hours (48-72), P<0.001] and a lower visual analog pain scale 36 hours after surgery [1 (1-2) vs. 2 (1-2), P<0.001] than the MLS group. The length of hospital stay was similar in the two groups [5(4-6) vs. 5(4-5), P=0.599]. Following surgery, 38.5% of the TU-LESS patients and 41% of the MLS patients got adjuvant therapy (P=0.744). The median follow-up time for TU-LESS and MLS cohorts was 45 months (range: 20-66) and 43 months (range: 18-66), respectively. One TU-LESS patient and one MLS patient died following recurrence. The 4-year overall survival was similar in both groups (98.3% vs. 98.5%, P=0.875). TU-LESS is a feasible and safe option with comparable perioperative outcomes and survival of MLS in endometrial cancer. With the growing acceptance of sentinel lymph node biopsy, TU-LESS of endometrial cancer may be a viable option for patients and surgeons.

Does transvaginal natural orifice transluminal endoscopic surgery affect female sexual function?: a prospective cohort study

BackgroundTo evaluate the effect of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) on female sexual function. Methods: The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2100050887, 07/09/2021). In this prospective cohort study, we prospectively analyzed the data of the female sexual function index (FSFI) questionnaire of 130 patients who underwent laparoscopy in Chengdu Women’s and Children’s Central Hospital due to gynecological benign diseases. The patients were assigned to the vNOTES group and the control group (underwent traditional laparoscopic surgery or transumbilical laparoendoscopic single-site surgery). Results: There were 4 cases dropout in the vNOTES group and 2 cases dropout in the control group. There was no difference in the ages (31.70 ± 5.02 vs. 30.37 ± 5.74, P>0.05), BMI (body mass index, 21.76 ± 3.16 vs. 23.30 ± 2.69, P>0.05), Education level, surgical types, and FSFI scores (22.31 ± 2.25 vs. 21.55 ± 3.38) between the vNOTES group and the control group before surgery. There was no difference in FSFI scores six months postoperation between the vNOTES group and the control group (21.61 ± 3.22 vs. 20.99 ± 3.26, P>0.05), and there was no difference in FSFI scores pre- and six months postoperation in vNOTES group (21.61 ± 3.22 vs. 22.31 ± 2.25, P>0.05). The time to start sexual life after surgery in the vNOTES group was later than that in the control group (39.34 ± 0.71 d versus 37.86 ± 0.69 d, P < 0.05). Conclusions: vNOTES has no significant adverse effect on female sexual function, however, the time to start sexual life after vNOTES is later than that after trans-abdominal laparoscopy.

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure.

Although previous studies have shown that vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantages of causing less pain, faster recovery, and better concealment of surgical incisions, which aligns with the concept of the day-care procedure, this approach poses a greater risk of damaging adjacent organs (i. e., rectum and bladder) due to its anatomical specificity. Moreover, the day-care procedure may lead to relatively less preoperative evaluation and postoperative care. Hence, it is necessary to explore the safety and effectiveness of vNOTES for ovarian cystectomy in the day-care procedure, to provide a theoretical basis for the wider development of vNOTES surgery. This retrospective study included 131 patients at our hospital who underwent ovarian cystectomy from September 2021 to October 2022. Based on the surgical approach, patients were classified into transumbilical laparoendoscopic single-site surgery (LESS) and vNOTES groups. The patients' demographic characteristics and follow-up data were collected during the perioperative period and 1-month postoperatively. Vaginal natural orifice transluminal endoscopic surgery has less postoperative exhaust time, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use, with higher surgical conversion incidence. Multiple linear regression analysis showed that the surgical conversion, chocolate cyst, bilateral cyst, and pelvic adhesion increased the operation duration by ~43 (95% CI: 10.309, 68.152, p < 0.001), 15 (95% CI: 6.342, 45.961, p = 0.036), 10 (95% CI: 3.07, 40.166, p = 0.019), and 8 (95% CI: 4.555, 26.779, p = 0.035) min, respectively. Interestingly, vNOTES decreased the operation duration by ~8.5 min (95% CI: -18.313, -2.699, p = 0.033). Vaginal natural orifice transluminal endoscopic surgery was equally safe and effective for ovarian cystectomy compared to LESS. vNOTES aligned with the concept of the day-care procedure due to its reduced postoperative pain, shorter exhaust time, and absence of scarring. However, surgeons should conduct a comprehensive preoperative evaluation and exclude patients suspected to have severe pelvic adhesions.

Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study.

We aimed to compare the outcomes of ovarian cystectomy (OC) performed by vaginal natural orifice transluminal endoscopic surgery (vNOTES) vs transumbilical laparoendoscopic single-site surgery (LESS). We retrospectively analyzed the data of patients in our hospital who underwent OC either by vNOTES or LESS between January 2015 and September 2021. Demographic data were collected. The primary outcome was the conversion rate. The secondary outcomes were the duration of surgery, length of hospital stay, estimated blood loss, maximum body temperature within 48 hours after operation, and duration of maximum body temperature (hours), among others. Statistical analysis was done using the SPSS software. Exactly 284 patients were screened. The vNOTES and LESS groups consisted of 21 and 47 patients, respectively. There was no significant difference in the conversion rates between the two groups (0 vs 8.5% in vNOTES and LESS, respectively; p = 0.303). Compared with the vNOTES group, the LESS group had a larger cyst diameter (6.00 ± 2.32 vs 4.69 ± 1.29 cm; p = 0.004), more endometriotic cysts (42.6% vs 9.5%; p < 0.001), and more pelvic adhesions requiring adhesiolysis (57.4% vs 19.0%; p = 0.003). At baseline, there were no other differences between the groups. The secondary outcomes included a shorter duration of surgery (70.14 ± 27.30 vs 99.57 ± 36.26 minutes; p = 0.001) and lower estimated blood loss (64.29 ± 39.19 vs 163.43 ± 251.20 mL; p = 0.011) in the vNOTES group. Regression analysis showed the diameter of the ovarian cyst correlated with surgical time. The complication was comparable between the two groups. Above all, the advantages of vNOTES include an absence of visible scars, shorter surgical duration, and less blood loss when compared with LESS. Further large-scale prospective trials should confirm the results of our study.

Application of Single-Handed Trans-Umbilical Laparo-Endoscopic Single-Site Surgery Using the Suspension Line Method for Salpingectomy in Ectopic Pregnancy

Background: To evaluate the safety and feasibility of single-handed trans-umbilical single-site laparo-endoscopic surgery using the suspension-line method for salpingectomy in ectopic pregnancy. Methods: This study reviewed 54 patients with ectopic pregnancy who underwent salpingectomy in the First Affiliated Hospital of Xiamen University from June 2018 to June 2019. The control group (n = 29) was treated with routine two-handed trans-umbilical laparoendoscopic single-site surgery (TU-LESS), while the study group (n = 25) was treated with single-handed TU-LESS using the suspension line method. Results: There were no significant differences in clinical indicators such as operation time, postoperative recovery ventilation time, recovery time of β-human chorionic gonadotropin (β-HCG) to normal level, and postoperative complications (p &gt; 0.05) between two groups, whereas the patients in the study group suffered less pain and were more satisfied with the incision (p &lt; 0.05). Conclusions: Single-handed LESS using the suspension method can be safely and effectively applied to salpingectomy, with less trauma, more beautiful incision, and more comfortable operation.

Transvaginal natural orifice endoscopic surgery for myomectomy: Can it be a conventional surgery?

As a new minimally invasive surgery, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been proved to be suitable for the treatment of a variety of gynecological benign diseases. However, compared with other minimally invasive surgeries that have been widely used, such as conventional multiport laparoscopy and transumbilical laparoendoscopic single-site surgery (LESS), their advantages and disadvantages and how to choose are still unknown. The purpose of our study is to compare the advantages and disadvantages of the three minimally invasive surgeries in myomectomy and to provide theoretical basis for the wider development of vNOTES surgery. This retrospective study included 282 patients at our hospital who underwent laparoscopic myomectomy from May 2021 to March 2022. Based on the surgical approach, patients were classified into multiport, transumbilical LESS, and vNOTES groups. The patients' demographic characteristics and follow-up data were collected during the perioperative period and at 1 month postoperatively. Among the three procedures, vNOTES had the shortest anal exhaust time but also the highest postoperative infection rate. Multiple linear regression analysis showed that the operative time increased by 3.5 min for each 1 cm increase in myoma, and intraoperative bleeding increased by approximately 12 ml. The average duration of single pores increased by 25 min compared to that of multiports, and the operative duration increased by 10.48 min for each degree of adhesion. For gynecologists who have mastered vNOTES, this procedure has the same efficacy and safety as the two existing minimally invasive surgeries in myomectomy, but it shows obvious advantages in postoperative recovery.

Comparison of Transvaginal and Transumbilical Laparoscopic Single-Site Surgery for Ovarian Cysts

Background:Minimally invasive surgery is currently a preferred treatment for symptomatic ovarian cyst(s), with single-site techniques, such as transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal laparoendoscopic single-site surgery (TV-LESS), gaining increasing popularity. Although both methods have delivered positive outcomes, there is currently limited literature directly comparing TU-LESS and TV-LESS.Objectives:This study had two primary objectives: (1) to evaluate the safety and feasibility of TV-LESS and TU-LESS for the treatment of ovarian cysts and (2) to compare the surgical and postoperative outcomes of the two procedures.Method:This was a prospective observational clinical analysis of 81 patients with a diagnosis of benign ovarian cyst with indication for TV-LESS or TU-LESS. Surgeries were performed at a tertiary hospital between February 1, 2018 and January 31, 2020. Patients were divided into TV-LESS (n = 40) and TU-LESS groups (n = 40), with one excluded due to severe pelvic adhesive disease. Demographics, operation outcomes, and follow-up details were compared.Results:All 80 patients underwent uncomplicated procedures. The two groups were demographically matched (except age), with no difference in operation time, intra-operative blood loss, hemoglobin loss, and hospitalization costs (P > 0.05). However, TV-LESS patients had significantly faster time to ambulation (P < 0.001), faster time to return of bowel function (P < 0.001), less postoperative pain level (P < 0.001), and shorter length of hospital stay (P < 0.001). The cosmetic scores at 1, 4, and 24 weeks after surgery were also higher for the TV-LESS group.Conclusion:Our preliminary experience suggested that TU-LESS and TV-LESS are both feasible and safe for ovarian cystectomy and salpingo-oophorectomy. However, TV-LESS may provide three main advantages including: (1) fewer postoperative complications (i.e. incisional hernia); (2) less postoperative pain; and (3) improved cosmetic satisfaction.

WITHDRAWN: Transumbilical laparoendoscopic single-site surgery (TU-LESS) extraperitoneal approach for lymphadenectomy: an innovative method.

Ahead of Print article withdrawn by publisher.

Clinical cohort study of total hysterectomy via transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendoscopic single site surgery

Objective: To study the safety and feasibility of total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single site surgery (TU-LESS). Methods: The study was a retrospective cohort analysis. In West China Second University Hospital, from October 1, 2018 to June 30, 2019, the patients with an indication for hysterectomy due to benign uterine diseases were enrolled, and were grouped by the surgical procedure. Various post-operative surgical outcomes, including the success rate of operation, uterine volume, operative time, blood loss, intraoperative complications, postoperative complications, the first time of flatus, the preserved time of catheter after operation, and the length of hospitalization were measured. The data were assessed by the software of SPSS. Results: Totally 30 patients were included in the vNOTES group, and 77 patients were included in the TU-LESS group, all of the procedures were completed successfully without conversion to traditional multiport laparoscopy or laparotomy. Non differences were observed between two groups, including uterine volume [(165±36) vs (235±38) cm3, P=0.243], operation time [(150±41) vs (169±48) minutes, P=0.063], blood loss [(54±15) vs (54±14) ml, P=0.985], the rate of intraoperative complications [3% (1/30) vs 4% (2/77), P=1.000], the rate of postoperative complications [13% (4/30) vs 4% (3/77), P=0.095] and the rate of bilateral salpingo-oophorectomy [50% (15/30) vs 31% (24/77), P=0.069]. Patients in the vNOTES group had significantly less recovery time of intestine function [(1.7±0.5) vs (2.3±0.6) days, P=0.001], shorter time of indwelling catheter [(1.9±0.4) vs (2.3±0.6) days, P=0.004], and duration of hospitalization [(3.2±0.8) vs (3.6±0.9) days, P=0.045]. Conclusions: vNOTES and TU-LESS are both safe and feasible for total hysterectomy. Compared with TU-LESS, vNOTES may be a promising approach with earlier recovery, less injury and better cosmetic.

Comparative analysis of vaginal natural orifice transluminal endoscopic surgery versus transumbilical laparoendoscopic single-site surgery in ovarian cystectomy.

To objectively assess the safety, feasibility, advantages and disadvantages and health economics benefits of vaginal natural orifice transluminal endoscopic surgery (vNOTES) versus transumbilical laparoendoscopic single-site surgery (TU-LESS) in ovarian cystectomy. We retrospectively analyzed the data of all patients in our hospital who had undergone vNOTES and TU-LESS ovarian cystectomy due to 'unilateral ovarian cyst' from March 2019 to May 2020. Patients were classified into vNOTES group (86) and TU-LESS group (210) based on surgical paths. The patients' general characteristics and perioperative outcomes were compared. All 296 patients completed surgery with no need to switch to conventional laparoscopy or laparotomy procedures. There were no complications of Grade III, IV, V in Clavien-Dindo classification. There were two patients in the vNOTES group and four patients in the TU-LESS group with complications of Grade I, all of whom were treated with antipyretic drugs for postoperative fever. One patient in the TU-LESS group presented the complication of Grade II and was treated with blood transfusion due to postoperative anemia. The two groups had similar general characteristics. Perioperative outcomes: The visual analogue scale (VAS) scores 24 h postoperation were significantly lower in the vNOTES group than in the TU-LESS group. The cosmetic scores were significantly higher in the vNOTES group than in the TU-LESS group. Postoperative stay and time of flatus after surgery were significantly shorter in the vNOTES group than in the TU-LESS group. There was not significant statistical differences between the two groups in operation time, estimated blood loss, Hb decrease at 48 h postoperation, maximum body temperature in 48 h after surgery and hospital costs. It was proved to be safe and feasible in ovarian cystectomy by vNOTES. It worked better than TU-LESS in relieving postoperative pain, shortening postoperative stay and improving cosmetic effects and so on. As an emerging surgical path, large sample multicenter randomized controlled trials are required to further verify its safety and advantages.

1671 Transumbilical Notes Pectopexy: Tips and Tricks

Video Objective Pectopexy is the most effective procedure to treat pelvic organ prolapse and can be used as an alternative to sacrocolpopexy. The minimally invasive access for pectopexy is divided into single-port and multi-port with or without robotic assistance. Transumbilical natural orifice transluminal endoscopic surgery (transumbilical laparoendoscopic single site surgery, transumbilical LESS) is an emerging minimally invasive approach, which reduces abdominal incision and enhances aesthetics. Pectopexy is an ingenious combination of the two approaches, which achieves a good clinical effect. These advantages outweigh the difficulties in learning the new technique. Our purpose was to show the surgical skills of the transumbilical LESS. Setting Xinxiang City Central Hospital Gynecologic Oncology, China Interventions Transumbilical single-site laparoendoscopic pectopexy was performed, which was a combination of laparoendoscopic and single-site surgeries. Conclusion Transumbilical LESS allows the surgeon to perform iliopectineal ligament after accessing the entire abdomen via a single port. This procedure can achieve a good clinical effect.

Trans-Umbilical Laparo-Endoscopic Single Site Surgery with Hepatic Ductoplasty in Management of Childhood Choledochal Cyst: A Single Surgeon Experience with 46 Cases

Trans-Umbilical Laparo-Endoscopic Single Site Surgery with Hepatic Ductoplasty in Management of Childhood Choledochal Cyst: A Single Surgeon Experience with 46 Cases

Review of Laparoscopic Management of Mature Cystic Teratoma of Ovaries in Children.

Ovarian cystic mature teratomas (OCMTs) are the most frequent ovarian tumors in childhood. This review aimed to determine the feasibility and safety of laparoscopic management of OCMT. Literature was searched for terms “mature,” “ovarian,” “teratomas,” and “laparoscopy.” Primary endpoints were age at surgery, laparoscopic and surgical technique, intraoperative complications, postoperative morbidity, and associated pathology. Literature search revealed 11 articles published between 1998 and 2014 that met the inclusion criteria. There were 105 (n = 95 unilateral; n = 10 bilateral) patients for this analysis, with mean age at surgery being 13 years. Four laparoscopic approaches were opted: gasless transumbilical laparoendoscopic single-site (LESS) surgery (n = 19), gasless multiport surgery (n = 24), single-incision laparoscopic surgery (SILS) (n = 3), and pneumoperitoneum multiport laparoscopy (n = 59). The 10 patients with bilateral OCMT underwent ovary-sparing surgery: LESS-assisted extracorporeal bilateral cystectomy in which tumors were punctured by a balloon catheter (n = 2), intracorporeal cystectomy for gasless multiport laparoscopy (n = 5) with use of endobags to prevent spillage, and transperitoneal multiport laparoscopy (n = 3). OCMT was associated with ipsilateral and unilateral ovarian torsion in five and bilateral ovarian torsion in one patient with bilateral OCMT. In four patients with unilateral OCMT, salpingo-oophorectomy was performed. Intraoperative complications were laceration of utero-ovarian ligament and bladder injury during a suprapubic port placement. The mean follow-up was 31.9 months. Patients with unilateral or bilateral OCMT can be offered ovarian-sparing surgery laparoscopically with one of the following techniques: LESS, SILS or multiport laparoscopy with pneumoperitoneal or gasless. Long-term follow-up of these techniques has shown no recurrence with low postoperative morbidity and low intraoperative complications.

Comparison of transumbilical laparoendoscopic single-site heminephroureterectomy versus conventional open surgery for children with duplex kidney

Objective To compare the outcome of transumbilical laparoendoscopic single-site surgery with conventional open surgery for duplex kidney in children. Methods Retrospective analysis of 53 cases undergone partial nephrectomy, performed in 32 girls and 21 boys with the mean age of (35.8±36.8) months from March 2013 to September 2015. The patients were divided into 2 different groups by odd and even outpatient service numbers. Group A: conventional open surgery of partial nepherectomy(n=29); Group B: transumbilical laparoendoscopic single-site Heminephroureterectomy (n=24). In group A, there were 12 boys and 17 girls, 12 of ureterocele, 7 of vesieoureteral reflux (VUR), 9 cases were of ectopie ureter and 8 of urinary tract infection (UTI), mean age was (46.0±38.3)months. In group B, there were 9 boys and 15 girls, 10 of ureterocele, 4 of VUR, 5 cases were of ectopie ureter and 7 of UTI, mean age was(20.2±28.6)months. There was no statistically significant difference in age, gender composition, affected side. Results 53 operations were done successful. There was 1 case conversion to open surgery and 2 cases added an additional port besides the umbilicus in Group B, and all occurred in the early stage of the study. Compared Group A with Group B, the operation time[(137.0±28.8) min vs.(167.3±43.7) min, P=0.006]; blood loss[(45.7±28.8) ml vs.(23.2±43.7) ml, P=0.134]; blood transfusion (6 vs.4, P=0.709); time of resumption to a regular diet[(1.4±1.5) d vs.(1.4±1.1) d, P=0.785]; time of indwelling drainage tube [(5.1±1.6) d vs.(4.1±2.0) d, P=0.200]; postoperative hospital stay [(8.6±2.0) d vs.(8.6±2.0) d, P=0.725]. The mean time of follow up after surgery is 18.2 months (2-31 months). Complications after surgery between group A and B included hypertension (2 vs. 0, P=0.495); urinary tract infection (2 vs.3, P=0.824), distal ureteric stump(DVS) (0 vs.1, P=0.453) and renal functional loss (1 vs.0, P=1.000). Conclusion The transumbilical laparoendoscopic single-site heminephrectomy is safe, feasible, effective in experienced pediatric urologic surgeons and high volume centres. It can reach or even exceed the effect of traditional open surgery. After the learning period, the operation time was significantly shortened, and can reach or be lower than open surgery time. Transumbilical laparoendoscopic single-site surgery (LESS) has the advantages of reduce the surgical trauma and better cosmetic results. Key words: Laparoendoscopic; Duplex kidney; Heminephroureterectomy; Laparoendoscopic single-site surgery

Safety and feasibility of modified transumbilical laparoendoscopic single-site simple nephrectomy

Objective To evaluate the safety and feasibility of applying modified transumbilical laparoendoscopic single-site surgery(LESS) nephrectomy in the treatment of kidney benign diseases. Methods From June 2012 to February 2014, 15 patients(group A)with benign nonfunctioning kidney were performed transumbilical laparoendoscopic single-site simple nephrectomy by an experienced laparoscopic surgeon. From February 2014 to December 2014, 10 patients(group B)with benign nonfunctioning kidney underwent modified transumbilical laparoendoscopic single-site simple nephrectomy by the same surgeon. Group A has 8 males and 7 females, with an average age of (51.3±5.5)years and an average body mass index of(22.5±1.3)kg/m2. Of the 15 patients, 10 were left benign nonfunctioning kidney while 5 were right. The causes of nonfunctioning kidney included renal calculi(7 cases), ureteral calculi(6 cases), and ureteropelvic junction obstruction(2 cases). Group B contains 4 males and 6 females, with an average age of(48.4±8.3)years and an average body mass index of(21.5±1.7)kg/m2. Of the 10 patients, 6 were left side benign nonfunctioning kidney while 4 were right. The causes of nonfunctioning kidney included renal calculi(4 cases), ureteral calculi(5 cases), and renal tuberculosis(1 case). An approximately 4 cm transverse incision was made below the umbilicus for single-port access in Group A. Operations were performed using 30°10 mm laparoscope with conventional and bending instruments. A 10 mm trocar next to the single-port access was added in group B without making a new skin incision, but with two incisions in the muscular layer. As two independent incisions, one is used for the single-port access, while the other is used for the 10mm trocar. This modified technique improves the procedure of the operation. A comparison was made between the two groups. Clinical indicators were collected before, during and after the operation, and complications of both groups were analyzed retrospectively. Results In group A, one case was converted to conventional laparoscopic nephrectomy, and 2 cases was added a trocar. Total operating time was significantly longer in group A than in group B[(201.0±31.5)min vs.(170.0±19.6)min, P=0.011)], but modified technique resulted in greater intra-operative blood loss[(134.7±42.7)ml vs.(174.4±43.9ml, P=0.034)]. There were no significant differences in resuming diet, leaving bed, removing drainage, visual analogue pain scale and length of hospital stay between the two groups. There was no severe complications in both groups, but an approximately 4 centimeters scar. Conclusions Modified transumbilical laparoendoscopic single-site simple nephrectomy was safe and effective. It can effectively reduce the operating time and learning curve, with improved cosmetic result. Key words: Transumbilical; Single-site; Laparoscopic surgery; Simple nephrectomy