Abstrakt Technologie Duben 2010

“Laparoendoscopic Single-site Repair of Retrocaval Ureter: First Case Report.”

Autorino, R., R. Khanna, et al. (2010).



Objective: We describe a case of retrocaval ureter treated with laparoendoscopic single-site surgery (LESS). Methods: A 26-year-old female was referred to our institution with a history of intermittent right-sided flank pain. Radiological imaging demonstrated hydronephrosis, suggesting the presence of a retrocaval ureter. A LESS repair was planned. Results: Retrograde pyelogram confirmed a classic appearance for retrocaval ureter. A ureteral stent was positioned. The patient was placed in modified flank position. A 2-cm, completely concealed umbilical access was created, through which a single port access platform was positioned. An in-line endoscope was used for visualization. Articulating instruments were used during initial dissection. The entire ureter was mobilized posterior to the vena cava and transected at the caudal-most point where the dilated portion of the proximal ureter ended. The distal ureter was repositioned lateral to the inferior vena cava and spatulated laterally. The proximal ureter was spatulated medially. Two 4-0 Vicryl sutures were used for the ureteroureteral anastomosis. A separate 2-mm grasper placed in the right lower quadrant was used to assist with suture reconstruction. A drain was left through the umbilicus. Blood loss was minimal. Total operative time was 3 hours. The patient was discharged on postoperative day 2. At the 3-month follow-up, diuretic radionuclide scan revealed no evidence of obstruction of the right kidney and the patient was symptom-free. Conclusions: Albeit challenging, LESS repair for retrocaval ureter is a feasible procedure that can be considered as a treatment option for this rare anatomic anomaly. © 2010 Elsevier Inc. All rights reserved.




“Re: Luca Cindolo, Stefano Gidaro, Fabiola R. Tamburro, Luigi Schips. Laparo-Endoscopic Single-Site Left Transperitoneal Adrenalectomy. Eur Urol 2010;57:911-4.”

Autorino, R., R. J. Stein, et al. (2010).

European Urology 57(5).




“Intraperitoneal virtual biopsy by fibered optical coherence tomography (OCT) at natural orifice transluminal endoscopic surgery (NOTES).”

Cahill, R. A., M. Asakuma, et al. (2010).

Journal of Gastrointestinal Surgery 14(4): 732-738.


Introduction: Fibered optical coherence tomography (OCT) in conjunction with natural orifice transluminal endoscopic surgery (NOTES) could provide a facility for rapid, in situ pathological diagnosis of intraperitoneal tissues in a truly minimally invasive fashion. Materials and Methods: A large porcine model was established to test this hypothesis. A standard double channel gastroscope (Olympus) was used to achieve a transgastric access to the peritoneum and initiate the pneumoperitoneum. Magnetic retraction was used to display the sigmoid colon along with its mesentery. A commercially available fibered OCT probe (NIRIS system, Imalux) was inserted via a working channel of the gastroscope and used to assess intraperitoneal tissues. Separately, OCT images of human tissue specimens ex vivo were contrasted with representative standard histopathological slides. Results: Intraperitoneal OCT provided clear real-time images of both the serosal and muscularis propria mural layers as well as the submuscosal-muscularis interface. Examination of mesenteric lymph nodes (including sentinel nodes) allowed visualization of their subcapsular sinus. Comparison of representative cross-sections however failed to evince sufficient resolution for confident diagnosis. Conclusion: This approach is technically feasible and, if the technology is advanced and proven accurate in human patients, could potentially be used to individualize operative extent prior to definitive resection. © 2009 The Society for Surgery of the Alimentary Tract.




“Laparo-Endoscopic Single-Site Left Transperitoneal Adrenalectomy.”

Cindolo, L., S. Gidaro, et al. (2010).

European Urology 57(5): 911-914.


A 53-yr-old woman presented with abdominal pain. Ultrasonography, computed tomography, and an endocrinologic work-up revealed a 4-cm nonfunctional left adrenal mass. A TriPort laparoscopic adrenalectomy was performed. The TriPort was inserted through a 3-cm subcostal incision. Using 5-mm instruments, a left adrenalectomy was performed. The specimen was dissected (harmonic scalpel) and extracted through a 10-mm bag. A TriPort adrenalectomy was successfully completed in 240 min (blood loss: 20 ml). The postoperative period was uneventful (discharge within 3 d). In our opinion, the TriPort adrenalectomy is feasible and safe, with favourable perioperative and short-term outcomes and a delighted patient at the 8-mo follow-up. © 2009 European Association of Urology.




“Laparoendoscopic single-site (LESS) surgery in patients with benign adnexal disease.”

Escobar, P. F., M. A. Bedaiwy, et al. (2010).

Fertility and Sterility 93(6).


Objective: To present our initial experience in laparoscopic surgery for benign adnexal disease performed exclusively through an umbilical incision using a single three-channel port and flexible laparoscopic instrumentation. Design: Case report. Setting: Tertiary-care referral center. Patient(s): Since November, 2008, we have performed single-port laparoscopic surgery in nine patients diagnosed with benign adnexal disease. Patients with adnexal masses or endometriosis and a body mass index of &lt;35 kg/m<sup>2</sup> were selected. Intervention(s): Laparoendoscopic single-site (LESS) surgery. In each case, a multichannel port was inserted into the peritoneum through a 1.5-2.0-centimeter umbilical incision. Main Outcome Measures: Feasibility, postoperative pain score, age, BMI, estimated blood loss. Result(s): Eight of nine cases were completed successfully, without conversion to a standard laparoscopic approach or to laparotomy. An additional 3 mm extraumbilical port was required in one patient with stage 4 endometriosis. Seven out of nine patients had earlier abdominal surgery. The operative blood loss ranged from minimal to 75 mL. Duration of hospital stay was &lt;24 hours in all cases. Minimal use of postoperative narcotics was required, and no intraoperative complications occurred. Conclusion(s): The LESS surgery for benign adnexal disease is feasible in patients with or without earlier surgery. Additional investigation is needed to evaluate the safety and long-term outcomes of this new approach. © 2010 American Society for Reproductive Medicine.




“Initial Experience With 50 Laparoendoscopic Single Site Surgeries Using a Homemade, Single Port Device at a Single Center.”

Jeon, H. G., W. Jeong, et al. (2010).

Journal of Urology 183(5): 1866-1872.


Purpose: We report our technique of and initial experience with 50 patients who underwent laparoendoscopic single site surgery using a homemade single port device at a single institution. Materials and Methods: Between December 2008 and August 2009 we performed 50 laparoendoscopic single site surgeries using the Alexis® wound retractor, which was inserted at the umbilical incision. A homemade single port device was made by fixing a size 71/2 surgical glove to the retractor outer ring and securing the glove fingers to the end of 3 or 4 trocars with a tie and a rubber band. A prospective study was performed in 50 patients to evaluate outcomes. Results: Of 50 patients 34 underwent conventional laparoendoscopic single site surgery, including radical and simple nephrectomy, and cyst decortication in 8 each, nephroureterectomy in 3, partial nephrectomy and adrenalectomy in 2 each, and partial cystectomy, ureterectomy and ureterolithotomy in 1 each, while 16 underwent robotic laparoendoscopic single site surgery, including partial nephrectomy in 11, nephroureterectomy in 3, and simple and radical nephrectomy in 1 each. Mean patient age was 52 years, mean body mass index was 23.4 kg/m<sup>2</sup>, mean operative time was 201 minutes and mean estimated blood loss was 201 ml. Four intraoperative complications occurred, including 2 bowel serosal tears, diaphragm partial tearing and conversion to open radical nephrectomy. One case of postoperative bleeding was managed by transfusion. Surgical margins were negative in the 13 patients who underwent partial nephrectomy. Mean hospital stay was 4.5 days (range 1 to 16). Conclusions: Our homemade single port device is cost-effective, provides adequate range of motion and is more flexible in port placement for laparoendoscopic single site surgery than the current multichannel port. © 2010 American Urological Association Education and Research, Inc.




“Single Incision Miniature Pyeloplasty and Ipsilateral Inguinal Herniorrhaphy in Infants.”

Kajbafzadeh, A. M., A. Tourchi, et al. (2010).

Journal of Urology 183(4): 1545-1550.


Purpose: We describe a single incision miniature open pyeloplasty and retroperitoneal herniorrhaphy technique in infants. Materials and Methods: A total of 22 patients with ureteropelvic junction obstruction and concomitant inguinal hernia were referred to our center between November 2003 and November 2008. A total of 13 patients (mean age 5 months) with extensively dilated pelves (extending down to pelvic cavity) and ipsilateral inguinal hernia underwent single incision miniature open pyeloplasty and retroperitoneal herniorrhaphy. All patients had decreased differential renal function (less than 40%), urinary tract infection, palpable kidney and obstructive pattern on renal diethylenetriamine pentaacetic acid scan. The incision was made along the most dependent part of the lower quadrant. After dissection of the ureteropelvic junction component, we pulled out the affected section and performed classic dismembered pyeloplasty without renal pelvis reduction. Next, we performed retroperitoneal herniorrhaphy from the same incision. Surgical incision size, operative time, hospital stay, postoperative analgesic use and complication rate were recorded for further evaluation. Results: The operation was uneventful in all patients. Mean operative time was 64 minutes (range 47 to 93) and patients were discharged home after a mean ± SD of 19 ± 3 hours (15 to 24). Incision size was 12 to 18 mm and the incision was closed by inserting a mini Hemovac® closed drain. No narcotic supplementation was required postoperatively and there were no complications during followup. Conclusions: Single incision miniature pyeloplasty with ipsilateral inguinal herniorrhaphy in an extensively dilated pelvis and ipsilateral inguinal hernia is technically feasible and safe in selected cases. The exact incision site must be reconfirmed intraoperatively by physical examination or renal ultrasound. The technique adds the advantages of minimally invasive procedures (small incision, negligible postoperative pain) to the short operative time and high success rate of the open approach. © 2010 American Urological Association Education and Research, Inc.




“Editorial: Editorial comment on laparoendoscopic single-site surgery: Initial experience.”

Lima, E. (2009).

Editorial: Comentario editorial sobre Laparo-endoscopia por acceso único: Experiencia inicial 33(2): 110-111.




“Single-Incision Laparoscopic Cholecystectomy: Initial Experience with Critical View of Safety Dissection and Routine Intraoperative Cholangiography.”

Rawlings, A., S. E. Hodgett, et al. (2010).

Journal of the American College of Surgeons.