Korean J Urol.  2010 Sep;51(9):613-618.

Initial Experience with Laparoendoscopic Single-Site Surgery by Use of a Homemade Transumbilical Port in Urology

• Lee SY
• Kim YT
• Park HY
• Lee TY
• Park SY

Abstract

PURPOSE
We present our initial experience with laparoendoscopic single-site surgery (LESS) by a single surgeon in the urologic field.
MATERIALS AND METHODS
From May 2009 to April 2010, 30 consecutive patients underwent LESS including seven cases of nephrectomy, five cases of nephroureterectomy with bladder cuff excision, four cases of ureterolithotomy, eight cases of marsupialization, and six cases of varicocelectomy. We performed a retrospective analysis of the medical records of the above patients. The single port was made with a surgical glove and an Alexis(R) wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). The wound retractor was put into the peritoneal space through an umbilical incision, and a laparoscopic triangle was secured by crossing both instruments. All operations were performed by the transperitoneal approach.
RESULTS
Mean patient age was 54.8 years. Mean operative time was 171.2+/-109.1 minutes. Mean estimated blood loss was 265.0+/-395.5 ml. Mean incision length was 3.2+/-1.4 cm. Mean length of hospitalization was 5.2+/-2.9 days. There was one laparoscopic conversion and two open conversions. There were two cases of transient ileus that improved with conservative treatment. Mean visual analogue pain scales on the operative day and first postoperative day were 6.3/10 and 3.1/10, respectively.
CONCLUSIONS
In our experience, LESS for urologic surgery is feasible, safe, and clinically applicable. We consider the homemade single-port device to be a relatively cost-effective and convenient device. If surgical instruments for LESS and appropriate ports specified for LESS are developed, LESS would be a surgical treatment technique that could be used as an alternative to the conventional types of laparoscopic surgery.

Keyword

Instrumentation; Laparoscopy; Surgical gloves; Urology

MeSH Terms

Gloves, Surgical
Hospitalization
Humans
Ileus
Laparoscopy
Medical Records
Nephrectomy
Operative Time
Pain Measurement
Retrospective Studies
Surgical Instruments
Urinary Bladder
Urology

Figure

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  FIG. 1 Homemade single-port device (A). Inlet of surgical glove put on the outer ring as the plastic sleeve is turned inside out (B). Instruments and laparoscope positioning during laparoendoscopic single-site surgery (LESS) (C). Schematic illustration showing intraperitoneal positioning of instruments and laparoscope through the port device. Homemade single-port device was made by tying fingers of size 6 1/2 surgical glove to the ends of 4 trocars with rubber bands (D).

Reference

1. Piskun G, Rajpal S. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A. 1999. 9:361–364.

2. Kaouk JH, Haber GP, Goel RK, Desai MM, Aron M, Rackley RR, et al. Single-port laparoscopic surgery in urology: initial experience. Urology. 2008. 71:3–6.

3. White WM, Haber GP, Goel RK, Crouzet S, Stein RJ, Kaouk JH. Single-port urological surgery: single-center experience with the first 100 cases. Urology. 2009. 74:801–804.

4. Tai HC, Lin CD, Wu CC, Tsai YC, Yang SS. Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS). Surg Endosc. 2010. 24:705–708.

5. Park YH, Kang MY, Jeong MS, Choi H, Kim HH. Laparoendoscopic single-site nephrectomy using a homemade single-port device for single-system ectopic ureter in a child: initial case report. J Endourol. 2009. 23:833–835.

6. Han WK, Park YH, Jeon HG, Jeong W, Rha KH, Choi H, et al. The feasibility of laparoendoscopic single-site nephrectomy: initial experience using home-made single-port device. Urology. 2009. Epub ahead of print.

7. Jeong BC, Park YH, Han DH, Kim HH. Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study. J Endourol. 2009. 23:1957–1960.

8. Park YH, Park SY, Kim HH. Laparoendoscopic single-site nephroureterectomy with bladder cuff excision for upper urinary tract transitional-cell carcinoma: technical details based on oncologic principles. J Endourol. 2010. 24:563–566.