Laparoendoscopic single-site surgery for benign urologic disease with a homemade single port device: design and tips for beginners

Abstract

Purpose: A single surgeon skilled in conventional laparoscopic surgery used laparoendoscopic single-site surgery (LESS) to treat benign urological diseases. This study reports our surgical results and introduces a simple technique with tips based on our experience.

Materials and methods: LESS surgery was performed on 116 patients by use of a homemade single-port device composed of an Alexis wound retractor and a powder-free surgical glove. Cases were 44 varicocelectomies (including 8 bilateral cases), 38 renal cyst marsupializations (including 3 bilateral cases), 26 ureterolithotomies (with 1 concomitant ureterolithotomy and contralateral renal cyst marsupialization), 4 prostatic enucleations, and 4 bladder rupture repairs. The mean patient age was 44.43±16.46 years (range, 11 to 76 years), and the male-to-female ratio was 87:29.

Results: In one ureterolithotomy case, LESS was converted to conventional laparoscopic surgery. The mean operative time was 87.03±45.03 minutes, the estimated blood loss was 61.90 ml (range, 0 to 2,000 ml), and the mean hospital stay was 3.03±2.12 days. Two patients underwent single-port transvesical enucleation of the prostate (STEP) requiring patient-controlled anesthesia. No patients developed major complications, and all patients were satisfied, with 75.86% expressing a high degree of satisfaction.

Conclusions: We report successful treatment outcomes for LESS in 116 cases of benign urological disease. Our findings suggest that LESS can replace conventional laparoscopy.

Keywords: Laparoscopy; Surgical procedures, minimally invasive; Urology.

FIG. 1

(A) to (E) Homemade single-port device. (A) Both ends of the wound retractor were securely tightened. (B) The white upper ring was folded three times. (C) and (D) One size 6 and 1/2 surgical glove was placed in the upper ring and folded 6 to 7 times. (E) A wound retractor was placed in the transumbilical incision, which was opened by using a Hasson technique.

FIG. 2

(A) Surgery was performed by bending the tip of the articular laparoscopic equipment to a shape similar to the basic fifth movement of ballet. (B) To secure the space, a gas valve was placed either superiorly or inferiorly. This minimized interference from the trocar head. (C) Methods for confirming the insertion of instruments through the transparent part of the wound retractor by pulling on a homemade single-port device. (D) Methods of specimen extraction following the cutting of another finger of the glove.