Limits...
Concomitant laparoendoscopic single-site surgery for ureterolithotomy and contralateral renal cyst marsupialization.

Lee JY, Lee SW - Korean J Urol (2011)

Bottom Line: A 63-year-old woman presented with acute right-flank pain and left-flank pain.Flexible laparoscopic instruments and conventional rigid instruments were used during LESS following a procedure similar to that used with conventional laparoscopic surgery without additional transcutaneous ports.LESS may be more efficient at treating bilateral diseases than is conventional laparoscopic surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT
A 63-year-old woman presented with acute right-flank pain and left-flank pain. Computed tomography identified a right ureter stone and a left renal cyst. The patient underwent concomitant laparoendoscopic single-site surgery (LESS) for ureterolithotomy and renal cyst marsupialization with the use of an Alexis® wound retractor, which was inserted through the umbilical incision. Flexible laparoscopic instruments and conventional rigid instruments were used during LESS following a procedure similar to that used with conventional laparoscopic surgery without additional transcutaneous ports. LESS may be more efficient at treating bilateral diseases than is conventional laparoscopic surgery.

No MeSH data available.


Related in: MedlinePlus

(A) A 10 mm rigid laparoscope was inserted into the peritoneum through a 12 mm trocar, and the laparoscopic instruments (LaparoAngle®; CambridgeEndo, Framingham, MA, USA) were inserted into the other two trocars. The intraoperative photograph shows the renal cyst (B), which was exposed with the use of LaparoAngle® dissectors (CambridgeEndo), and the suture on the right side of the ureter (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC3037509&req=5

Figure 2: (A) A 10 mm rigid laparoscope was inserted into the peritoneum through a 12 mm trocar, and the laparoscopic instruments (LaparoAngle®; CambridgeEndo, Framingham, MA, USA) were inserted into the other two trocars. The intraoperative photograph shows the renal cyst (B), which was exposed with the use of LaparoAngle® dissectors (CambridgeEndo), and the suture on the right side of the ureter (C).

Mentions: Under general anesthesia, the patient was placed in the flank position with the left side elevated by 70°. A 3 cm crescenteric marginal skin incision around the umbilicus and a 1 cm extended fascial incision were made. We used a small Alexis® wound retractor (Applied Medical, Rancho, Santa Margarita, CA, USA) and a powder-free surgical glove (Triplex P-free Glove®; KM Healthcare, Guri, Korea) to insert the homemade single-port device (Fig. 2A). The wound retractor was inserted at the site of the single incision. The homemade single-port device was constructed by fixing and rolling the surgical glove to the outer ring of the wound retractor so that it would not fall off; two 12 mm trocars and a 5 mm trocar were used to secure the fingers of the size 6 1/2 surgical glove to the end of three trocars with a silk 1-0 suture. A 10 mm rigid laparoscope (30°) was inserted through the middle 12 mm trocar, and the laparoscopic instruments were inserted through the other two trocars because the 5 mm and 10 mm flexible laparoscopes were not equipped for insertion. Two flexible laparoscopic instruments (LaparoAngle®; CambridgeEndo, Framingham, MA, USA) were inserted and configured in revere alignment ("mirror-imaging"); conventional rigid instruments were used occasionally. After dissection of Gerota's fascia, renal cyst fluid was aspirated by tapping. The cystic fluid underwent cytologic and chemical testing, and its color and volume were assessed (Fig. 2B). The cystic wall was resected and sent out for histologic analysis. The remaining renal cystic wall was electrocauterized to prevent recurrence. After the LESS technique on the left side of the patient was completed, the patient was repositioned to expose the right side (Fig. 1C, D). The repositioning to the right side took approximately 20 minutes. After resection of the line of Toldt, the large intestine was tacked to the medial side and the ureter was exposed within the peritoneum. After the location of the stone was determined, a longitudinal incision was made with a pair of laparoscopic Metzenbaum scissors. The ureter stone was extracted easily and rapidly with laparoscopic forceps through one finger of the device. The vertically resected ureter was closed with an uninterrupted 5-0 polyglactin suture, and a drainage tube was placed at the anastomosis site of the ureter (Fig. 2C). A double-J stent was inserted with cystocopy and fluoroscopy after skin suture. The surgical procedure lasted 210 minutes (left side: 50 minutes; right side: 160 minutes), and the estimated blood loss was 100 ml. Postoperatively, the patient was able to tolerate a diet and received no self-administered analgesia. On postoperative day 4, the drainage tube was removed, and the patient was discharged home. No complications were observed during the postoperative period. On postoperative day 21, the ureteral stent was removed. A diagnosis of simple renal cyst was made on the basis of pathologic and cytologic examination. The patient experienced no complications after removal of the ureteral stent and did not complain of right- or left-flank pain.


Concomitant laparoendoscopic single-site surgery for ureterolithotomy and contralateral renal cyst marsupialization.

Lee JY, Lee SW - Korean J Urol (2011)

(A) A 10 mm rigid laparoscope was inserted into the peritoneum through a 12 mm trocar, and the laparoscopic instruments (LaparoAngle®; CambridgeEndo, Framingham, MA, USA) were inserted into the other two trocars. The intraoperative photograph shows the renal cyst (B), which was exposed with the use of LaparoAngle® dissectors (CambridgeEndo), and the suture on the right side of the ureter (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3037509&req=5

Figure 2: (A) A 10 mm rigid laparoscope was inserted into the peritoneum through a 12 mm trocar, and the laparoscopic instruments (LaparoAngle®; CambridgeEndo, Framingham, MA, USA) were inserted into the other two trocars. The intraoperative photograph shows the renal cyst (B), which was exposed with the use of LaparoAngle® dissectors (CambridgeEndo), and the suture on the right side of the ureter (C).
Mentions: Under general anesthesia, the patient was placed in the flank position with the left side elevated by 70°. A 3 cm crescenteric marginal skin incision around the umbilicus and a 1 cm extended fascial incision were made. We used a small Alexis® wound retractor (Applied Medical, Rancho, Santa Margarita, CA, USA) and a powder-free surgical glove (Triplex P-free Glove®; KM Healthcare, Guri, Korea) to insert the homemade single-port device (Fig. 2A). The wound retractor was inserted at the site of the single incision. The homemade single-port device was constructed by fixing and rolling the surgical glove to the outer ring of the wound retractor so that it would not fall off; two 12 mm trocars and a 5 mm trocar were used to secure the fingers of the size 6 1/2 surgical glove to the end of three trocars with a silk 1-0 suture. A 10 mm rigid laparoscope (30°) was inserted through the middle 12 mm trocar, and the laparoscopic instruments were inserted through the other two trocars because the 5 mm and 10 mm flexible laparoscopes were not equipped for insertion. Two flexible laparoscopic instruments (LaparoAngle®; CambridgeEndo, Framingham, MA, USA) were inserted and configured in revere alignment ("mirror-imaging"); conventional rigid instruments were used occasionally. After dissection of Gerota's fascia, renal cyst fluid was aspirated by tapping. The cystic fluid underwent cytologic and chemical testing, and its color and volume were assessed (Fig. 2B). The cystic wall was resected and sent out for histologic analysis. The remaining renal cystic wall was electrocauterized to prevent recurrence. After the LESS technique on the left side of the patient was completed, the patient was repositioned to expose the right side (Fig. 1C, D). The repositioning to the right side took approximately 20 minutes. After resection of the line of Toldt, the large intestine was tacked to the medial side and the ureter was exposed within the peritoneum. After the location of the stone was determined, a longitudinal incision was made with a pair of laparoscopic Metzenbaum scissors. The ureter stone was extracted easily and rapidly with laparoscopic forceps through one finger of the device. The vertically resected ureter was closed with an uninterrupted 5-0 polyglactin suture, and a drainage tube was placed at the anastomosis site of the ureter (Fig. 2C). A double-J stent was inserted with cystocopy and fluoroscopy after skin suture. The surgical procedure lasted 210 minutes (left side: 50 minutes; right side: 160 minutes), and the estimated blood loss was 100 ml. Postoperatively, the patient was able to tolerate a diet and received no self-administered analgesia. On postoperative day 4, the drainage tube was removed, and the patient was discharged home. No complications were observed during the postoperative period. On postoperative day 21, the ureteral stent was removed. A diagnosis of simple renal cyst was made on the basis of pathologic and cytologic examination. The patient experienced no complications after removal of the ureteral stent and did not complain of right- or left-flank pain.

Bottom Line: A 63-year-old woman presented with acute right-flank pain and left-flank pain.Flexible laparoscopic instruments and conventional rigid instruments were used during LESS following a procedure similar to that used with conventional laparoscopic surgery without additional transcutaneous ports.LESS may be more efficient at treating bilateral diseases than is conventional laparoscopic surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.

ABSTRACT
A 63-year-old woman presented with acute right-flank pain and left-flank pain. Computed tomography identified a right ureter stone and a left renal cyst. The patient underwent concomitant laparoendoscopic single-site surgery (LESS) for ureterolithotomy and renal cyst marsupialization with the use of an Alexis® wound retractor, which was inserted through the umbilical incision. Flexible laparoscopic instruments and conventional rigid instruments were used during LESS following a procedure similar to that used with conventional laparoscopic surgery without additional transcutaneous ports. LESS may be more efficient at treating bilateral diseases than is conventional laparoscopic surgery.

No MeSH data available.


Related in: MedlinePlus