Limits...
Laparoendoscopic single-site surgeries: a single-center experience of 171 consecutive cases.

Choi KH, Ham WS, Rha KH, Lee JW, Jeon HG, Arkoncel FR, Yang SC, Han WK - Korean J Urol (2011)

Bottom Line: There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications).Conversion to mini-incision open surgery occurred in seven (4.1%) cases.Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution.

Materials and methods: Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases.

Results: Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma.

Conclusions: Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.

No MeSH data available.


Related in: MedlinePlus

Robotic laparoendoscopic single-site partial nephrectomy. (A) A homemade single-port device was established by inserting two 12 mm trocars and two 8 mm trocars through the fingers of the surgical gloves. The scope was placed at a 30° upward angle to the robotic arms. (B) Renal vessel clamping.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC3037504&req=5

Figure 2: Robotic laparoendoscopic single-site partial nephrectomy. (A) A homemade single-port device was established by inserting two 12 mm trocars and two 8 mm trocars through the fingers of the surgical gloves. The scope was placed at a 30° upward angle to the robotic arms. (B) Renal vessel clamping.

Mentions: The homemade single-port system was placed for R-LESS (da Vinci S, Intuitive Surgical, Sunnyvale, USA) as it was for C-LESS. Two 12 mm trocars and two 5 mm trocars were used. The camera was inserted through the 12 mm trocar and the robot arms were inserted thorough the 8 mm port [13]. In most cases, an additional trocar was inserted alongside the port device to create a 12 mm hybrid port. To prevent the outer clashing of robotic arms, the scope was placed at a 30° upward angle to the robotic arms (Fig. 2A) [13]. We maintained intra-abdominal pressure under 12 mmHg and checked the glove to ensure that it did not inflate. All surgical procedures were performed with the homemade single-port device (Fig. 1B-D, 2B).


Laparoendoscopic single-site surgeries: a single-center experience of 171 consecutive cases.

Choi KH, Ham WS, Rha KH, Lee JW, Jeon HG, Arkoncel FR, Yang SC, Han WK - Korean J Urol (2011)

Robotic laparoendoscopic single-site partial nephrectomy. (A) A homemade single-port device was established by inserting two 12 mm trocars and two 8 mm trocars through the fingers of the surgical gloves. The scope was placed at a 30° upward angle to the robotic arms. (B) Renal vessel clamping.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3037504&req=5

Figure 2: Robotic laparoendoscopic single-site partial nephrectomy. (A) A homemade single-port device was established by inserting two 12 mm trocars and two 8 mm trocars through the fingers of the surgical gloves. The scope was placed at a 30° upward angle to the robotic arms. (B) Renal vessel clamping.
Mentions: The homemade single-port system was placed for R-LESS (da Vinci S, Intuitive Surgical, Sunnyvale, USA) as it was for C-LESS. Two 12 mm trocars and two 5 mm trocars were used. The camera was inserted through the 12 mm trocar and the robot arms were inserted thorough the 8 mm port [13]. In most cases, an additional trocar was inserted alongside the port device to create a 12 mm hybrid port. To prevent the outer clashing of robotic arms, the scope was placed at a 30° upward angle to the robotic arms (Fig. 2A) [13]. We maintained intra-abdominal pressure under 12 mmHg and checked the glove to ensure that it did not inflate. All surgical procedures were performed with the homemade single-port device (Fig. 1B-D, 2B).

Bottom Line: There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications).Conversion to mini-incision open surgery occurred in seven (4.1%) cases.Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution.

Materials and methods: Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases.

Results: Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma.

Conclusions: Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.

No MeSH data available.


Related in: MedlinePlus