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

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.

Keywords: Kidney; Laparoscopy; Minimally invasive surgical procedures; Robotics; Ureter.

FIG. 1

Conventional laparoendoscopic single-site surgery. (A) A homemade single-port device and laparoscopic instruments for right radical nephrectomy. (B) Renal hilar dissection with articulating hook electrocautery. (C) Ureteropelvic reconstruction with a straight laparoscopic needle holder. We used the first stitch string for internal traction of the ureter. A double-J stent was inserted in the distal ureter; the proximal coil was not yet inserted. (D) Urachal mass excision using an additional 2 mm MiniLap Alligator clamp (Stryker, NY, USA, left).

FIG. 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.

FIG. 3

Abdomen 1 month after surgery.