Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port).
ABSTRACT To report an initial clinical urologic experience with a new laparoscopic access port (R-Port) and the advent of the single-port access (SPA) procedure and one-port umbilical surgery (OPUS).
Five patients underwent therapeutic laparoscopic interventions (two simple nephrectomies for end-stage kidney disease consequent to stone disease, one orchidopexy, one orchidectomy, and one ureterolithotomy), with one R-Port used for each. Three of these procedures were OPUS, and the other two were SPA procedures. In all cases a 5-mm 30 degrees telescope and two 5-mm working instruments were inserted through the port. In the case of the nephrectomies, hemostasis and pedicle control was obtained with the Harmonic Scalpel and Hem-o-lok clips; a novel multi-instrument port cap allowed for safe introduction of a 10-mm clip applier. Frequent instrument changes effected as necessary to allow the operative procedure to proceed to completion did not affect the seal.
All procedures were completed uneventfully. Operative time averaged 83 minutes. There were no perioperative port-related or surgical complications in these cases.
The R-Port allows laparoscopic surgery to be performed safely with fewer ports, thereby allowing for SPA and OPUS with their inherent cosmetic advantages and reduction in postoperative discomfort. More studies are being carried out.
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ABSTRACT: Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. Laparoendoscopic single-site surgery (LESS) potentially takes this further. Following the first human urological LESS report in 2007, numerous case series have emerged, as well as comparative studies comparing LESS with standard laparoscopy. However, comparative series between conventional laparoscopy and LESS for different procedures suggest a non-inferiority of LESS over standard laparoscopy, but the only objective benefit remains an improved cosmetic outcome. Challenging ergonomics, instrument clashing, lack of true triangulation, and in-line vision are the main concerns with LESS surgery. Various new instruments have been designed, but only experienced laparoscopists and well-selected patients are pivotal for a successful LESS procedure. Robotic-assisted LESS procedures have been performed. The available robotic platform remains bulky, but development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.Korean journal of urology 07/2012; 53(7):443-50.
Article: Single-incision versus conventional laparoscopic cholecystectomy: a systematic review of available data.[show abstract] [hide abstract]
ABSTRACT: To evaluate the feasibility and limitation of single-incision laparoscopic cholecystectomy (SILC), we performed a systematic literature search and 11 studies were included. SILC was successfully performed in 91.9% participants and conventional instruments were used mostly. Although longer operative time was required for this novel procedure than the conventional laparoscopic cholecystectomy, mean difference was 18.54 minutes (P=0.0001) and a learning curve was noted. There was no significant discrepancy in overall complications and severe complications (P=0.51 and 0.82, respectively). No difference in the length of hospital stay between the 2 groups was detected (P=0.09). No consensus has reached on the postoperative pain score between the 2 techniques. SILC with conventional instruments was a feasible and safe approach. It may be offered as an alternative for cholecystectomy in carefully selected patients.Surgical laparoscopy, endoscopy & percutaneous techniques 08/2012; 22(4):e190-6. · 1.23 Impact Factor
Article: Laparo-endoscopic single-site (LESS) bilateral nephroureterectomy for patients with end-stage renal disease.[show abstract] [hide abstract]
ABSTRACT: Abstract We present the first report of LESS bilateral nephroureterectomy via the transperitoneal approach using the home-made single port. Two patients received LESS bilateral nephroureterectomies and bladder cuffs resection with homemade single ports, which were created by using an Alexis wound retractor as an access platform through a 4 cm incision. Distal ureters were resected through the same incision with Endo-loop. No additional ports were used and both procedures were completed successfully without traditional laparoscopic/open conversion or complication. LESS nephreoureterectomy with bladder cuff excision was performed in 460 and 635 minutes with an estimated blood loss of 50 and 400 mL, respectively. Patients were discharged on postoperative day 3 and 7, respectively. Our report demonstrates that LESS bilateral nephroureterectomy and bladder cuff resection is a safe and feasible procedure for urothelial carcinoma of upper urinary tract in patients at dialysis.Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 11/2012; · 1.33 Impact Factor