Limits...
Laparoendoscopic Single-Site Pyeloplasty Using Additional 2 mm Instruments: A Comparison with Conventional Laparoscopic Pyeloplasty.

Ju SH, Lee DG, Lee JH, Baek MK, Jeong BC, Jeon SS, Lee KS, Han DH - Korean J Urol (2011)

Bottom Line: But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024).Our initial experiences suggest that LESS-P is a feasible and safe procedure.The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P).

Materials and methods: Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting.

Results: The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months).

Conclusions: Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

No MeSH data available.


Related in: MedlinePlus

2 mm needlescopic instruments assist with suturing by manipulating tissue, adjusting in needle direction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC3198235&req=5

Figure 3: 2 mm needlescopic instruments assist with suturing by manipulating tissue, adjusting in needle direction.

Mentions: To perform LESS-P, the patient was placed in the semilateral decubitus position under general anesthesia. A 2-cm midline longitudinal incision was made at the umbilicus. We used a wound retractor (Alexis®; Applied Medical, Rancho Santa Margarita, CA, USA) and a surgical glove as the homemade single-port device as described in our previous series [11]. To make a single port similar to that of a commercial multichannel trocar, the inner ring of the wound retractor was inserted at the umbilicus. An outer ring was attached to a size 6½ surgical glove. We firmly fastened the first, third, and fifth glove finger tips to the end of the three trocars (two 12 mm trocars and one 5 mm trocar) with a tie or rubber band [11]. Pneumoperitoneum was made by CO2 gas insufflation to 14 mm Hg, and a 10 mm rigid laparoscope angled at 30 degrees was inserted. The operation was performed by using conventional laparoscopic straight working instruments and 5 mm articulating instruments (Autonomy Laparo-angle™; Cambridge Endo, Framingham MA, USA) to overcome the lack of triangulation that occurs with a single port. We also used additional needlescopic instruments with a 2 mm trocar inserted at the subcostal area to create an environment similar to that for conventional laparoscopic pyeloplasty with ureteropelvic anastomosis (Fig. 1, 2). The 2 mm grasper was used to assist with suturing by manipulating the renal pelvis or ureter and adjusting the needle direction (Fig. 3). During dissection at the right pyeloplasty, a 2 mm trocar was also initially used for liver traction. The anastomosis was performed by means of a continuously running suture with 4-0 polygalactin suture. A ureteral stent was inserted antegradely through the 2 mm trocar by using a 5 Fr. catheter and guide-wire. The 2 mm trocar site did not need to be closed after the operation. In the CL-P group, we used two 12 mm trocars and one or two 5 mm trocars.


Laparoendoscopic Single-Site Pyeloplasty Using Additional 2 mm Instruments: A Comparison with Conventional Laparoscopic Pyeloplasty.

Ju SH, Lee DG, Lee JH, Baek MK, Jeong BC, Jeon SS, Lee KS, Han DH - Korean J Urol (2011)

2 mm needlescopic instruments assist with suturing by manipulating tissue, adjusting in needle direction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3198235&req=5

Figure 3: 2 mm needlescopic instruments assist with suturing by manipulating tissue, adjusting in needle direction.
Mentions: To perform LESS-P, the patient was placed in the semilateral decubitus position under general anesthesia. A 2-cm midline longitudinal incision was made at the umbilicus. We used a wound retractor (Alexis®; Applied Medical, Rancho Santa Margarita, CA, USA) and a surgical glove as the homemade single-port device as described in our previous series [11]. To make a single port similar to that of a commercial multichannel trocar, the inner ring of the wound retractor was inserted at the umbilicus. An outer ring was attached to a size 6½ surgical glove. We firmly fastened the first, third, and fifth glove finger tips to the end of the three trocars (two 12 mm trocars and one 5 mm trocar) with a tie or rubber band [11]. Pneumoperitoneum was made by CO2 gas insufflation to 14 mm Hg, and a 10 mm rigid laparoscope angled at 30 degrees was inserted. The operation was performed by using conventional laparoscopic straight working instruments and 5 mm articulating instruments (Autonomy Laparo-angle™; Cambridge Endo, Framingham MA, USA) to overcome the lack of triangulation that occurs with a single port. We also used additional needlescopic instruments with a 2 mm trocar inserted at the subcostal area to create an environment similar to that for conventional laparoscopic pyeloplasty with ureteropelvic anastomosis (Fig. 1, 2). The 2 mm grasper was used to assist with suturing by manipulating the renal pelvis or ureter and adjusting the needle direction (Fig. 3). During dissection at the right pyeloplasty, a 2 mm trocar was also initially used for liver traction. The anastomosis was performed by means of a continuously running suture with 4-0 polygalactin suture. A ureteral stent was inserted antegradely through the 2 mm trocar by using a 5 Fr. catheter and guide-wire. The 2 mm trocar site did not need to be closed after the operation. In the CL-P group, we used two 12 mm trocars and one or two 5 mm trocars.

Bottom Line: But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024).Our initial experiences suggest that LESS-P is a feasible and safe procedure.The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P).

Materials and methods: Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting.

Results: The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months).

Conclusions: Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

No MeSH data available.


Related in: MedlinePlus