Korean J Urol.  2011 Sep;52(9):616-621.

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

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.

Keyword

Laparoscopy; Minimally invasive; Surgical procedure; Ureteral obstruction

MeSH Terms

Analgesics
Cohort Studies
Humans
Laparoscopy
Length of Stay
Operative Time
Stents
Umbilicus
Ureter
Ureteral Obstruction
Analgesics

Figure

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  FIG. 1 2 mm needlescopic instruments.

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  FIG. 2 2 mm needlescopic instruments were inserted to create an environment similar to that of conventional laparoendoscopic surgery.

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

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  FIG. 4 A photograph of the operation scar: the single skin incision is often hidden within the umbilicus.

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