Wound Retractor Research Articles

Laparoendoscopic Single-Site Renal Cyst Marsupialization Using a Homemade Single-Port Device Has a Role as a Feasible Treatment Option

Aim: In patients with a renal cyst and concurrent symptoms, we examined the effectiveness and safety of laparoendoscopic single-site surgery (LESS) for renal cyst marsupialization using a homemade single-port device (HSPD) by a single surgeon (S.W.L.). Patients and Methods: The present study was conducted on a total of 31 patients with a renal cyst. A LESS renal cyst marsupialization was performed using a HSPD based on the Alexis® wound retractor and a powder-free surgical glove. In our study, the mean age was 55.29 ± 10.86 (range 31–73) years and the mean size of the renal cyst was 6.83 ± 1.09 cm. Results: All the surgical procedures were successfully performed. The mean operative time was 101.35 ± 16.04 min. Of the patients who underwent the procedure, none presented with major complications. In 7 patients who had pain preoperatively, there was a significant difference in the visual analogue pain scale score at 6.86 ± 0.69 preoperatively and 1.71 ± 0.49 at postoperative week 4 (p < 0.001). The number of patients who were satisfied with the postoperative outcome was 29 (93.5%). Conclusions: In patients with a simple renal cyst, LESS renal cyst marsupialization using a HSPD might be considered as a feasible, safe surgical treatment option.

Initial Experience of Laparoendoscopic Single-site Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Urothelial Carcinoma Performed by a Single Surgeon

To present our experience with the first 10 consecutive cases of laparoendoscopic single-site nephroureterectomy (LESSNU) with bladder cuff excision for upper tract urothelial carcinoma. Ten patients (6 men and 4 women; 6 renal pelvis and 4 ureter) underwent LESSNU by a single surgeon. We made a 4-cm single incision at the umbilicus using a homemade single-port device. The single-port device was made with a surgical glove and Alexis wound retractor. LESSNU was performed by the same technique of conventional laparoscopic NU. The mean age was 62.79 ± 7.93 years. The mean total operative time, time for nephrectomy, and time for bladder cuff excision were 225.6 ± 365.87, 80.00 ± 29.03, and 145.63 ± 42.63 minutes. The mean estimated blood loss was 187.50 ± 83.45 mL. On surgical pathologic examination, four patients were pT(1)N(0), four patients were pT(2)N(0), one patient was pT(3)N(0), and one patient was pT(3)N(2). There was one positive surgical margin in a pT(3)N(2) patient. The mean number of lymph nodes dissected was 2.5 (range 0-9). One incision extension was performed because of complete renal hilar lymphadenectomy by open technique (for the pT(3)N(2) patient), and one open conversion with a Gibson incision was performed because of severe adhesions around the distal ureter (the pT(3)N(0) patient). There were one case of transient ileus and one of fever that were improved with conservative treatment. The mean hospital stay was 4.75 ± 3.37 days. Eight patients who underwent LESSNU successfully were satisfied with their operations. LESSNU for upper urinary tract urothelial carcinoma seems to be feasible and safe, but it is still challenging for advanced cases.

Successful pregnancy outcome after laparoscopic-assisted excision of a bizarre leiomyoma: a case report

IntroductionBizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation. Especially when diagnosed in a younger woman, this tumor leads to challenging treatment issues involving fertility preservation. Owing to the low incidence of bizarre leiomyoma, there is insufficient evidence to support myomectomy alone as an appropriate management option. Also, the impact of bizarre leiomyoma on fertility is not well known.Case presentationA 30-year-old Japanese woman who had never given birth was referred to us because of a uterine tumor with an unusual diagnostic image and was treated by a gasless laparoscopic-assisted excision with a wound retractor. Owing to an unclear margin between her uterine tumor and myometrium, a concomitant excision of adjacent myometrial tissue was required to achieve the maximum resection of her tumor. The histopathological diagnosis was bizarre leiomyoma. Seven months later, she conceived spontaneously and her pregnancy course was uneventful. At 37 weeks of gestation, an elective cesarean section was performed. Although a slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted.ConclusionsA laparoscopic-assisted excision of bizarre leiomyoma is a feasible and minimally invasive conservative measure for a woman who wishes to preserve fertility.

Laparoendoscopic Single-Site Nephroureterectomy and En Bloc Resection of Bladder Cuff with an Endoloop

Introduction: To present the initial experience of laparoendoscopic single-site (LESS) nephroureterectomy via the transperitoneal approach using a homemade single port and bladder-cuff resection by endoloop. Materials and Methods: LESS nephroureterectomy was performed with a homemade single port created using an Alexis wound retractor as an access platform through a 4-cm incision over umbilicus.1 This video included a brief presentation of a 57-year-old woman who presented with painless gross hematuria. An upper tract high-grade urothelial carcinoma was identified. The LESS nephroureterectomy and bladder-cuff resection were performed through the same incision over the umbilicus. The distal ureters were resected with an endoloop.2 The procedure was completed. No additional ports were used. The outside shots demonstrating the maneuvering the instruments were also included in our slides. Results and Conclusions: Between August 2009 and May 2010, we have performed LESS nephroureterectomy for five consecutive patients with upper tract urothelial carcinomas. The mean operative time was 284.0 ± 94.9 minutes. The mean estimated blood loss was 70.0 ± 24.5 mL. The mean hospital stay was 5.6 ± 3.5 days. Complete bladder-cuff resection was confirmed grossly in all cases. None of our cases had a urinary leakage, which was confirmed by cystography postoperatively. There is only one laparoscopic conversion caused by tight adhesions of renal hilum surroundings, which made progress difficult. There was no operation-related complication. Histopathologic examination demonstrated negative-resection margins in all cases. Our initial experience revealed that LESS nephroureterectomy and use of endoloop to complete bladder-cuff resection is a safe and feasible procedure for upper urinary tract urothelial carcinoma. Further prospective and long-term studies are warranted to provide more solid evidence with regard to perioperative benefits and oncologic control. All authors have declared no conflicts of interest. Runtime of video: 8 mins 45 secs

Laparoendoscopic Single-Site Ureterolithotomy for Upper Ureteral Stone Disease: The First 30 Cases in a Multicenter Study

We evaluated the usefulness of laparoendoscopic single-site (LESS) ureterolithotomy with a homemade single port device for upper ureteral stones in patients in whom previous shockwave lithotripsy or ureteroscopic stone surgery had failed or the stone was suspected to be impacted. LESS ureterolithotomy was performed on 30 patients by using a homemade single port device composed of an Alexis wound retractor and surgical glove. The mean age of the patients was 42.47±11.15 years (range 24-65 y), and the male-to-female ratio was 13:17. The mean stone diameter was 1.77±0.47 cm. One patient underwent a bilateral operation for bilateral ureteral stones. The LESS surgery was converted to conventional laparoscopic surgery in one case. The mean operative time was 110.43±43.75 minutes. The mean length of hospital stay was 3.40±1.54 days. None of the patients used patient-controlled anesthesia, and none presented with major complications. The visual analog pain scale score improved significantly by postoperative day 7 (from 6.87±1.61 preoperatively to 1.67±1.16; P<0.001), and 28 (93.3%) patients said they were satisfied with the postoperative outcome. Postoperative radiologic evaluation revealed that the stones had been removed completely in 28 cases. There were no cases of urinary leakage. LESS ureterolithotomy using a homemade single port device can be considered to be a feasible and safe alternative to conventional laparoscopic ureterolithotomy.

Single-port versus conventional laparoscopic salpingectomy in tubal pregnancy: a comparison of surgical outcomes

ObjectiveTo compare the surgical outcomes of single-port laparoscopic salpingectomy (SPLS) and conventional laparoscopic salpingectomy for the surgical treatment of tubal pregnancy. Study designFrom January to June 2009, patients with tubal pregnancy were assigned to two surgical groups: SPLS and conventional laparoscopic salpingectomy. Surgical outcomes, including operative time, postoperative haemoglobin drop, hospital stay and complications, were compared prospectively. For SPLS, a novel multichannel port was made using a wound retractor and a surgical glove. ResultsIn total, 60 patients were enrolled in the study (30 in the SPLS group and 30 in the conventional group). All operations were completed successfully. No significant difference was observed between the two groups in terms of mean operative time (52.6±16.1min vs 46.8±16.2min; p=0.174), mean difference between pre- and postoperative haemoglobin (1.7±0.8g/dl vs 1.8±1.0g/dl; p=0.636), or mean postoperative hospital stay (2.4±0.5 days vs 2.4±0.9 days; p=1.000). No complications were encountered in either group, and there was no conversion to conventional laparoscopy in the SPLS group. ConclusionSPLS has comparable surgical outcomes to conventional laparoscopic salpingectomy for the surgical treatment of tubal pregnancy in terms of operative time, hospital stay and complication rates. However, further studies are needed to evaluate the merits expected of single-port laparoscopic surgery, such as cosmetic advantage and decreased pain in patients.

Laparoendoscopic single-site totally extraperitoneal adult inguinal hernia repair: initial 100 patients

This report aims to describe the authors' initial experience with laparoendoscopic single-site (LESS) totally extraperitoneal (TEP) inguinal hernia repair in 100 patients. Patients who underwent an elective LESS TEP inguinal hernia repair between December 2008 and September 2010 in a single center were enrolled prospectively in this study. Patient demographic data, hernia characteristics, and operative and postoperative outcomes were analyzed. An Alexis wound retractor was placed through the 2-cm subumbilical incision as a homemade transumbilical access platform after the preperitoneal space was created by a balloon dissector. Standard procedures of TEP all were finished using conventional straight laparoscopic instruments. Of the 100 patients in this study, 2 underwent conversion to LESS transabdominal preperitoneal (TAPP) repair. The remaining 98 patients received successful LESS TEP inguinal hernia repair by a single surgeon. No patient required open or conventional laparoscopic conversion. However, one patient did experience recurrence. The mean operative time was 64.2 min, and the hospital stay was 1.54 days. One patient with a history of bladder surgery had a minor intraoperative bladder injury. No major postoperative complication occurred, but 11 patients had seroma or hematoma, 2 had epididymitis, 2 had urinary tract infection, 1 had wound dehiscence, 1 had wound infection, and 1 had urinary retention. This single-arm observational study was limited by the absence of a control cohort. Based on our experience, in the hands of experienced laparoscopic surgeons, LESS TEP repair for adult inguinal hernia using the homemade port as an access platform is feasible and safe and provides acceptable operative outcomes.

Transumbilical Single-Port Laparoscopic Transabdominal Preperitoneal Repair of Inguinal Hernia

Conventional laparoscopic repair of inguinal hernias is generally performed by using 3 ports. In this study, the authors report their initial experiences of transumbilical single-port transabdominal preperitoneal (TAPP) repair of inguinal hernia using a unique "single port." Since November 2008, transumbilical single-port TAPP was performed in 24 patients with an inguinal hernia. A wound retractor and a surgical glove attached with 5 mm trocar and 2 pipes were inserted through a 1.5 cm-sized transumbilical incision. TAPP procedure was performed similarly compared with conventional laparoscopy. Transumbilical single-port TAPP repair of an inguinal hernia was successfully performed in 24 patients (19 male and 5 female; 17 with an indirect hernia and 7 with a recurrent hernia; mean age 54.2 y; mean body mass index 24.2 kg/m). No major or minor intraoperative and postoperative complication was encountered and no conversion to conventional 3-port approach or open surgery was required. Mean operating time was 65.6 minutes and mean hospital stay was 2.1 postoperative days. Transumbilical single-port TAPP repair of an inguinal hernia is technically feasible, provides nearly scarless surgery and can be performed safely and effectively in selected patients with an inguinal hernia.

Laparoendoscopic Single-Site Retroperitoneal Lumbar Sympathectomy: Initial Report

Retroperitoneoscopic lumbar sympathectomy is a safe and effective treatment for plantar hyperhidrosis. To evaluate the safety and feasibility of laparoendoscopic single-site retroperitoneal lumbar sympathectomy in plantar hyperhidrosis. Bilateral laparoendoscopic single-site retroperitoneal lumbar sympathectomy was performed in a 27-year-old man who suffered from excessive sweating from the soles of the feet. A homemade single port was created with an Alexis wound retractor through a 2.5-cm incision at the tip of the 12th rib. With conventional 5-mm laparoscopy and instruments, retroperitoneal lumbar sympathectomy was performed. The procedure was completed successfully without any complications and with minimal blood loss. The operative time was 110 and 80 minutes for the procedure on the left and right sides. The perioperative course and postoperative course were uneventful. The patient had anhidrosis of both feet after surgery with Hyperhidrosis Disease Severity Scale score of 1 at the 1-month follow-up. Laparoendoscopic single-site retroperitoneal lumbar sympathectomy is a safe and feasible procedure according to our initial experience.

Laparoendoscopic Single-Site Nephropexy with Homemade Single Port

Introduction: Laparoscopic nephropexy is a safe and effective procedure for symptomatic floating kidney. The posterior retroperitoneoscopic approach is thought to be the most promising method for single-access surgery of the floating kidney. Here, we report our preliminary experiences in laparoendoscopic single-site surgery (LESS) retroperitoneal nephropexy with homemade single port for symptomatic floating kidneys. Materials and Methods: LESS retroperitoneal nephropexy was performed with a homemade single port that was created using an Alexis wound retractor as an access platform through a 2-cm incision beneath the tip of 12th rib.1 This video included a brief presentation of a case of a 65-year-old woman who presented with recurrent urinary tract infection and intermittent right flank soreness when activity. She was a slim woman with a body mass index of 21. The flank soreness was usually exacerbated by an upright position and relived by recumbence. Then, supine and erect intravenous pyelography was performed and it revealed downward displacement of two vertebral bodies of right kidney on erect position. The procedure was completed successfully without conversion. The operative time was 110 min. Results and Conclusions: Between May 2009 and July 2010, we had performed LESS nephropexy for four consecutive patients with symptomatic floating kidneys (bilateral in 1 and right in 3). The mean patient age was 44.6±17.7 years and mean body mass index was 21.4 kg/m2. The mean operative time was 121.0±29.7 min. Mean estimated blood loss was minimal, and mean hospital stay was 3.3±0.5 days. Conversion to an open or conventional retroperitoneoscopic approach was not necessary in all cases. There was no major complication. Follow-up intravenous pyelography study 3 months after procedure revealed that the treated kidneys were in the desired position and axis with a standing descend less than one vertebral body in all patients. In conclusion, LESS retroperitoneal nephropexy with homemade single port is a safe and feasible procedure for symptomatic floating kidneys. Further prospective and long-term studies are warranted to provide more solid evidence with regard to perioperative benefits of LESS nephropexy. All authors have declared no conflicts of interest. Runtime of video: 7 mins 1 sec Shih-Dong Chung and Victor Chia-Hsiang Lin contributed equally to this work.

Gasless laparoscopically assisted myomectomy using a wound retraction system

The purpose of this study was to elucidate the feasibility of gasless laparoscopically assisted myomectomy (LAM) using a wound retraction system. This method treats symptomatic uterine myomas by combining laparoscopy with a mini-laparotomy to enucleate myoma nodules and to close the uterine myometrium. This study includes 275 patients who underwent gasless LAM. For patients with fewer than three myoma nodules, the location of the largest nodule was classified as anterior, fundal, or posterior. The operative outcomes, intraoperative and postoperative courses, and complications were examined. All operations were performed satisfactorily, and no conversions to laparotomy were required. None of the patients developed serious complications. The mean blood loss and operating time were 190.3 mL and 152.2 minutes, respectively. The mean myoma size was 8.9 cm, and the mean number of myomas per patient was 2.8. The average postoperative hospital stay was 5.7 days. There were no significant differences in resected myoma size, blood loss, and surgical duration with respect to the location of the largest nodule. Gasless LAM with a wound retractor is feasible and allows surgeons to perform myomectomy safely and cost-effectively, without requiring advanced laparoscopic surgical skills and while maintaining minimum invasiveness.

Laparoendoscopic single-site surgery (LESS) for adnexal tumors: one surgeon's initial experience over a one-year period

In this article, we present our initial experience with laparoendoscopic single-site surgery (LESS) for adnexal tumors and report on the safety and feasibility of this technique. We retrospectively reviewed the medical records of the first 94 consecutive patients who underwent LESS for adnexal tumors at Cheil General Hospital and Women's Healthcare Center, Seoul, Korea between March 2009 and July 2010. Our retrospective chart review was approved by our local Institutional Review Board (IRB). We used a homemade wound retractor and surgical glove as the single-port device. All LESS procedures were performed by a single surgeon. Of 94 patients, 90 (95.7%) successfully underwent LESS for the treatment of an adnexal tumor. The mean age of the patients was 38.51 ± 11.65 years, and the mean body mass index was 21.22 ± 2.79 kg/m(2). The mean operative time was 50.33 ± 13.26 min, and the mean diameter of the adnexal tumors was 6.26 ± 3.19 cm. The procedures included enucleation of an ovarian cyst (n=56), salpingo-oophorectomy (n=32), and salpingectomy (n=4). Two cases with suspicion for malignancy underwent conversion to laparotomy (2.1%), and frozen sections revealed serous ovarian adenocarcinoma (n=1) and chronic inflammation (n=1). Except for those two cases, the pathologic diagnoses were confirmed as mature cystic teratoma (n=30), endometriosis (n=24), mucinous cystadenoma (n=14), serous cystadenoma (n=14), borderline ovarian tumor (n=4), hydrosalpinx (n=4), serous adenocarcinoma of the salpinx (n=1), and ectopic pregnancy (n=1). Two cases required an additional trocar for adhesiolysis of severe pelvic adhesion. No major intraoperative or postoperative complications occurred. Our results suggest that LESS is a safe and feasible alternative to conventional laparoscopic surgery for the treatment of adnexal tumors.

Totally laparoscopic sigmoid colectomy with transanal specimen extraction

Conventional techniques for laparoscopic-assisted colectomy (LAC) require abdominal minilaparotomy for extraction of the specimen. Abdominal wound complications often increase the invasiveness of LAC. To decrease the incidence of wound complications, natural orifice specimen extraction (NOSE) has been reported. However, only a few devices that allow smooth extraction and reduced intracorporeal contamination have been reported previously. We performed totally laparoscopic sigmoid colectomy using transanal specimen extraction (TASE) and the Alexis(®) wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). We document this simple and safe technique and its short-term results. We prospectively collected data on 18 patients who underwent totally laparoscopic sigmoid colectomy with TASE from April 2009 to July 2010. Lymph node dissection and transection of proximal and distal colon were performed in conventional manner. The transected rectal stump was opened transversely, and a long Babcock grasper was inserted transanally through the opened rectal stump. One of a pair of Alexis rings was held and pulled out of the anus. The other ring was placed in the opened rectal stump. The specimen was then extracted transanally through the Alexis. After the Alexis had been removed, the rectal opening was reclosed with a linear stapler. End-to-end colorectal anastomosis was then performed using the double-stapling technique. Transanal extraction was achieved in 17 cases. We switched to conventional LAC in a case involving a bulky specimen. In 16 cases not including the combined cholecystectomy case, mean operation time was 241min. One case was complicated by anastomotic leakage and wound infection, while another had enterocolitis. Median hospital stay was 6days. All patients remained disease free. Mean Wexner score at 12months after operation was 2.3. Totally laparoscopic sigmoid colectomy using TASE and the Alexis appears to be feasible, safe, and oncologically acceptable for selected cases.

Single-incision laparoscopic myomectomy with intracorporeal suturing

To assess the feasibility, safety, and operative outcomes of single-incision laparoscopic myomectomy with intracorporeal suturing. Retrospective descriptive study. Tokyo Medical and Dental University Hospital, Tokyo, Japan. Twelve patients who underwent single-incision laparoscopic myomectomy between July 2009 and June 2010 to remove single or multiple uterine myomas. All cases of single-incision laparoscopic myomectomy were performed by a single surgeon (N.Y.). Technical feasibility and operative outcomes. Cases consisted of six subserosal, four intramural, and two submucosal myomas. The mean operative time and weight of the largest myoma per patient were 100 minutes (range, 52-150 minutes) and 78 g (range, 15-284 g), respectively. Blood loss was minimal in all cases. All procedures were successfully performed, and there were no conversions to conventional multiport laparoscopy or open surgery. There were no postoperative complications or port-site hernias noted. We successfully performed single-incision laparoscopic myomectomy with intracorporeal suturing. Single-incision laparoscopic myomectomy with the glove wound retractor system is feasible and safe in select patients, and it provides almost no visible scar.

Isobaric laparoendoscopic single-site surgery with wound retractor for adnexal tumors: a single center experience with the initial 100 cases

ObjectiveTo report our experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery in 100 patients with adnexal tumors at a single center. Study designIn each case, a wound retractor was used as a working port through a 2.5-cm vertical umbilical incision. The surgical view was secured with the subcutaneous abdominal wall-lift method. Surgical procedures were performed using conventional laparoscopic instruments under vision with a rigid 30°, 5-mm EndoEYE laparoscope. Clinical data regarding patient demographics and surgical outcomes were retrospectively analyzed. ResultsBetween August 2009 and July 2010, one hundred and seventeen tumors from 100 cases were treated with isobaric LESS surgery (unilateral salpingo-oophorectomy, 46; unilateral cystectomy, 33; bilateral cystectomy, 8; bilateral salpingo-oophorectomy, 6; unilateral cystectomy and contralateral cyst wall ablation, 4; unilateral cystectomy and contralateral salpingo-oophorectomy, 2; and unilateral salpingectomy, 1). Three normal adnexa were prophylactically resected at the same time as contralateral salpingo-oophorectomy of a diseased ovary. Previous abdominal surgery was noted in 20 cases. Emergency surgery was performed in 7 cases. Six pregnant women were treated in the late first trimester. Median tumor diameter was 6.9cm. Median surgical duration was 55min and median blood loss was 10mL. Conversion to conventional laparoscopic surgery was noted in one case of recurrent endometriotic cyst with severe adhesion. Laparotomic conversion was not experienced. Prolonged administration of antibiotics with extended hospitalization was required in 7 cases due to elevated inflammatory parameters. There were no major surgical complications in this series. The technique yielded excellent cosmetic results with minimum postoperative scar concealed within the umbilicus. With exclusion of 4 endometriotic cysts treated with cyst wall ablation, pathological diagnosis was obtained for 113 tumors (dermoid cyst, 54; endometriotic cyst, 21; serous cystadenoma, 19; mucinous cystadenoma, 9; paraovarian cyst, 8; serous borderline tumor, 1; and paraovarian serous papillary borderline tumor, 1). ConclusionsWith efficient wound retraction to create a wide and flexible orifice during instrumentation, the transumbilical wound retraction system combined with the subcutaneous abdominal wall-lift method contributes favorably to LESS surgery as a safe, feasible and reproducible alternative for a variety of ablative and reconstructive applications in the management of adnexal tumors.

An improved technique for Soave trans-anal pull-through

To describe a new technique for the Soave trans-anal pull-through. After the mucosectomy during a Soave's procedure, a laparoscopic wound retractor was used to line the distal rectal segment to facilitate delivery of the proximal bowel through a narrow scarred pelvis. The technique greatly assisted delivery of the proximal bowel and helped prevent mesenteric injury. Soave trans-anal pull-through is a difficult operation that is largely confined to specialist centres. We describe an improvement to the technique that greatly facilitates the procedure.

A Wound Retraction Device for Laparoscopic‐Assisted Intestinal Surgery in Dogs and Cats

To report experience with laparoscopic-assisted intestinal resection and anastomosis for treatment of discrete intestinal masses using a novel wound retraction device. Case series. Dogs (n=2) and cats (6). Dogs and cats with discrete intestinal masses identified by ultrasonography without evidence of intestinal perforation or peritonitis, were included. A 2 portal technique was used; 1 portal was enlarged for insertion of the wound retraction device through which the intestine was examined as thoroughly as possible. The diseased portion of the intestine was exteriorized through the wound retractor and resection and anastomosis of the intestinal mass performed. Of the 8 animals, laparoscopic-assisted intestinal resection and anastomosis through the wound retractor was performed in 2 dogs and 3 cats. In 3 cats, based on either location or extent of the lesion, 2 were converted to laparoscopic-assisted intestinal biopsies and 1 to an open colocolostomy. No other intra- or perioperative complications were encountered and all animals survived to discharge. Laparoscopic-assisted intestinal resection and anastomosis can be performed in select canine and feline patients with modestly sized, discrete intestinal masses.

768 UROLOGIC LAPAROENDOSCOPIC SINGLE SITE SURGERIES USING HOMEMADE SINGLE PORT DEVICE: A SINGLE CENTER EXPERIENCE OF 200 CONSECUTIVE CASES

INTRODUCTION AND OBJECTIVES: With advancements in laparoscopic instruments, consideration of cosmesis and trends for minimal invasiveness, the number of laparoendoscopic single site surgery (LESS) has been performed for diverse urologic diseases. We report our experience with 200 patients who underwent LESS surgery using a homemade single port device in a single institution. METHODS: Between December 2008 to October 2010, 200 consecutive LESS urologic operations were done in Shinchon Severance hospital. Conventional LESS (C-LESS) and robotic LESS (RLESS; da Vinci S, Intuitive Surgical, USA) procedures were performed by three expert laparoscopic surgeons. All procedures were done using a homemade single port device with size 7 non-powdered surgical gloves and the Alexis¢c wound retractor which was inserted through a 2 to 4cm umbilical incision. The port device was made by placing gloves to the retractor outer ring by suturing and repeated folding to prevent air leak. A homemade single port was established by inserting three or four 12-mm and 8-mm trocars through the fingers of a surgical gloves and securing it to the port with rubber band. In R-LESS, an additional trocar was inserted in the midline below the subxiphoid process or alongside the homemade single port to establish a 12-mm hybrid port if needed. RESULTS: Of the 200 patients, 111 underwent C-LESS and 89 underwent R-LESS. Mean patient age was 53 years, mean operative time was 190.9 minutes, and mean estimated blood loss was 204 mL. Intraoperative complications occurred in seven cases (3.5%), and postoperative complications in nine cases (4.5%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification). Conversion to mini-incision open surgery occurred in eight (4%) cases. Regarding oncologic outcomes, there were five cases of distant metastasis in total 101 cases of cancer operation including aggressive progression of Ewing sarcoma and leiomyosarcoma. Two bladder recurrence was occurred in nephroureterectomy cases. Operative records, pathologic results and complication data are described in Table 1. CONCLUSIONS: LESS is technically feasible and safe for various urologic diseases. However, surgical experience and long-term follow-up are needed to test the superiority of LESS.

1172 ANTIBIOTIC PROPHYLAXIS IS NOT NECESSARY IN MINIMALLY INVASIVE SURGERY FOR RENAL AND ADRENAL TUMORS: A PROSPECTIVE STUDY OF 301 CONSECUTIVE PATIENTS

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 20111172 ANTIBIOTIC PROPHYLAXIS IS NOT NECESSARY IN MINIMALLY INVASIVE SURGERY FOR RENAL AND ADRENAL TUMORS: A PROSPECTIVE STUDY OF 301 CONSECUTIVE PATIENTS Toshiki Kijima, Soichiro Yoshida, Manabu Tatokoro, Saori Araki, Minato Yokoyama, Noboru Numao, Yohei Okada, Kazutaka Saito, Fumitaka Koga, Hitoshi Masuda, Yasuhisa Fujii, and Kazunori Kihara Toshiki KijimaToshiki Kijima Tokyo, Japan More articles by this author , Soichiro YoshidaSoichiro Yoshida Tokyo, Japan More articles by this author , Manabu TatokoroManabu Tatokoro Tokyo, Japan More articles by this author , Saori ArakiSaori Araki Tokyo, Japan More articles by this author , Minato YokoyamaMinato Yokoyama Tokyo, Japan More articles by this author , Noboru NumaoNoboru Numao Tokyo, Japan More articles by this author , Yohei OkadaYohei Okada Tokyo, Japan More articles by this author , Kazutaka SaitoKazutaka Saito Tokyo, Japan More articles by this author , Fumitaka KogaFumitaka Koga Tokyo, Japan More articles by this author , Hitoshi MasudaHitoshi Masuda Tokyo, Japan More articles by this author , Yasuhisa FujiiYasuhisa Fujii Tokyo, Japan More articles by this author , and Kazunori KiharaKazunori Kihara Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.784AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In AUA guideline, standard use of antibiotic prophylaxis is not recommended in open or laparoscopic surgery without entering urinary tract, except for patients with risk factors. This recommendation appears to be based on a general consensus in the field of abdominal surgery, however, and limited evidence is available in the field of urology. Gasless single port surgery has several features that may help reduce the incidence of infectious complications: a minimal incision, wound protection provided by the Alexis® wound retractor and completion of procedures without the insertion of fingers. In this study, we prospectively evaluated the incidences of surgical site infection (SSI) or other types of infection after gasless single port surgery for renal and adrenal tumors in the absence of antibiotic prophylaxis. METHODS We investigated 336 consecutive patients who underwent gasless single port total nephrectomy (n=171), partial nephrectomy (n=84) and adrenalectomy (n=81) between 2005 and 2010. Exclusion criteria were co-existing infection, uncontrolled diabetes mellitus, impaired immune responsiveness and opening of urinary tract during surgery. Patients who met these criteria were given a short course of second-generation cephalosporins. Perioperative infections were categorized into superficial SSI, deep SSI and other types of infection as defined by the US Centers for Disease Control and Prevention (CDC). Antibiotics were administered immediately upon diagnosis of perioperative infection. RESULTS Thirty-five (10%) of the 336 patients were excluded; the remaining 301 patients underwent radical nephrectomy (n=161), partial nephrectomy (n=73), or adrenalectomy (n=67) without antibiotic prophylaxis. There was no significant difference between these 3 groups in perioperative variables, including age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, length of operation, blood loss and National Nosocomial Infections Surveillance (NNIS) risk index. Incidences of superficial SSI, deep SSI and other types of infection in these 301 patients were 1.3%, 0.7%, and 3.0%, respectively; the differences of these values among 3 groups are not significant. All perioperative infections were successfully treated with additional antibiotics. CONCLUSIONS Antibiotic prophylaxis is not necessary in minimally invasive surgery for renal and adrenal tumors. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e470-e471 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Toshiki Kijima Tokyo, Japan More articles by this author Soichiro Yoshida Tokyo, Japan More articles by this author Manabu Tatokoro Tokyo, Japan More articles by this author Saori Araki Tokyo, Japan More articles by this author Minato Yokoyama Tokyo, Japan More articles by this author Noboru Numao Tokyo, Japan More articles by this author Yohei Okada Tokyo, Japan More articles by this author Kazutaka Saito Tokyo, Japan More articles by this author Fumitaka Koga Tokyo, Japan More articles by this author Hitoshi Masuda Tokyo, Japan More articles by this author Yasuhisa Fujii Tokyo, Japan More articles by this author Kazunori Kihara Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparoendoscopic Single-Site Radical Nephrectomy: A Comparison with Conventional Laparoscopy

To study the feasibility and safety of laparoendoscopic single-site (LESS) radical nephrectomy, we compared the operative results with conventional laparoscopic radical nephrectomy. Ten patients underwent LESS radical nephrectomy for renal tumors (group 1). Two types of single-port devices, a SILS port and a homemade single-port device that was made using a surgical glove and a wound retractor, were used through a 4-cm periumbilical incision. The operative results of LESS radical nephrectomy matched those of 12 patients who underwent conventional laparoscopic radical nephrectomy (group 2). For comparing the 2 groups, the Mann-Whitney U test and the Fisher exact test were used. LESS surgeries were completed successfully, without conversion to conventional laparoscopic or open surgery. The patients' characteristics did not differ significantly between the two groups. The mean operative times in groups 1 and 2 were 127.7 ± 22.3 minutes and 126.1 ± 43.1 minutes, respectively (P = 0.235). The mean estimated blood loss was 185.7 ± 121.9 mL and 324.0 ± 187.0 mL, respectively (P = 0.65). The complication rates were 10% and 17%, respectively (P = 0.658). The mean times to postoperative initiation of ambulation and initiation of oral intake were not different in the two groups (1.1 vs 1.0 days, P = 0.269; 1.0 vs 1.0 day, P = 1.0). The mean lengths of hospital stay were 6.5 and 6.1 days (P = 0.435). The mean tumor sizes were 4.0 cm and 5.2 cm (P = 0.345). LESS radical nephrectomy is technically feasible and comparable to conventional laparoscopy. Long-term follow-up and technical development, however, are needed for assessing the cancer-control effect and facilitating the minimal invasiveness of the surgery.