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Ren S, Zheng Y, Hu X, Bao Y, Wang D, Chang Y. Recent advances in single-site/incision robotic-assisted radical prostatectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1341-1350. [PMID: 36935223 DOI: 10.1016/j.ejso.2023.03.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Single-site robotic-assisted radical prostatectomy (ssRARP) has been successfully applied to treat prostate cancer. This review aims to describe the recent advances of surgical approaches, working accesses and novel robotic platforms in ssRARP. MATERIAL AND METHODS A systematic literature search was performed by searching the PubMed, EMBASE, Web of Science and Scopus databases in December 2022 to identify all literature related to ssRARP. RESULTS A total of 48 relevant studies were found worldwide from 2008 to 2023. Since the introduction of ssRARP, various modifications of this technique in surgical approaches, working accesses and novel robotic platforms have been developed. The application of ssRARP using the da Vinci SP platform has shown great superiority with encouraging clinical outcomes. DISCUSSION There has been a potential shift toward ssRARP using the da Vinci SP platform due to its potential advantages in terms of lower blood loss, minimal postoperative pain, better cosmetic outcome and rapid recovery. More convincing evidence, further technical improvement and higher cost-effectiveness are needed for its widespread acceptance.
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Affiliation(s)
- Shangqing Ren
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Yang Zheng
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610051, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Dong Wang
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.
| | - Yifan Chang
- Department of Urology, Changhai Hospital, Shanghai, 200433, China.
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Franco A, Pellegrino AA, De Nunzio C, Salkowski M, Jackson JC, Zukowski LB, Checcucci E, Vourganti S, Chow AK, Porpiglia F, Kaouk J, Crivellaro S, Autorino R. Single-Port Robot-Assisted Radical Prostatectomy: Where Do We Stand? Curr Oncol 2023; 30:4301-4310. [PMID: 37185441 PMCID: PMC10136812 DOI: 10.3390/curroncol30040328] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
In 2018, the da Vinci Single Port (SP) robotic system was approved by the US Food and Drug Administration for urologic procedures. Available studies for the application of SP to prostate cancer surgery are limited. The aim of our study is to summarize the current evidence on the techniques and outcomes of SP robot-assisted radical prostatectomy (SP-RARLP) procedures. A narrative review of the literature was performed in January 2023. Preliminary results suggest that SP-RALP is safe and feasible, and it can offer comparable outcomes to the standard multiport RALP. Extraperitoneal and transvesical SP-RALP appear to be the two most promising approaches, as they offer decreased invasiveness, potentially shorter length of stay, and better pain control. Long-term, high-quality data are missing and further validation with prospective studies across different sites is required.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | | | - Jamal C Jackson
- Department of Urology, Rush University, Chicago, IL 60612, USA
| | | | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy
| | | | | | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
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Progress in Control-Actuation Robotic System for Gastrointestinal NOTES Development. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7047481. [PMID: 36349314 PMCID: PMC9637469 DOI: 10.1155/2022/7047481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
Purpose Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgical procedure that reduces patient trauma, infection probability, and rehabilitation time. This paper reviews the progress made in the control-actuation robotic systems for gastrointestinal NOTES development. Material and Methods. A survey on both existing and state-of-the-art control-actuation robotic systems for gastrointestinal NOTES was conducted in December 2021. Results Nine control-actuation robotic systems for gastrointestinal NOTES were identified. The structures and specifications of these robotic systems were reported. The technical parameters were also discussed. Special attention was directed to systems using a control-actuation structure and tendon-driven mechanism. The control-actuation robotic systems typically deploy a control-actuation structure and tendon-driven mechanism. Control-actuation robotic systems for gastrointestinal NOTES show great ability to improve operational accuracy and flexibility and flatten the learning curve of procedures. These characteristics suggest that the use of control-actuation robotic systems is worth exploring in future development.
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Xu B, Peng YJ, Ma GZ, Zhang Q. A novel "three-port" trocar placement technique for laparoscopic radical prostatectomy. World J Surg Oncol 2020; 18:279. [PMID: 33109205 PMCID: PMC7592506 DOI: 10.1186/s12957-020-02051-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients. Methods We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A, three-port LRP; group B, conventional four-five-port LRP; group C, open RP (ORP); and group D, robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages. Results All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases of conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8 min, the mean estimated blood loss (EBL) was 94.2 ml, the mean drainage days was 4.0 days, the mean hospitalization was 5.1 days, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization, and transfusion in group A were statistically significant among the majority of the other groups (p < 0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased. Conclusions Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization, and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice.
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Affiliation(s)
- Ben Xu
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Yi-Ji Peng
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Guo-Zhong Ma
- Department of Urology, Affiliated Hospital of Heze Medical College, 777 Zhujiang Road, Mudan District, Heze City, 274000, Shandong, China
| | - Qian Zhang
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Billah MS, Stifelman M, Munver R, Tsui J, Lovallo G, Ahmed M. Single port robotic assisted reconstructive urologic surgery-with the da Vinci SP surgical system. Transl Androl Urol 2020; 9:870-878. [PMID: 32420202 PMCID: PMC7214978 DOI: 10.21037/tau.2020.01.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Single port (SP) robotic assisted laparoscopic surgery was approved by the FDA for urologic surgery and clinically available in 2018. This new robotic system enables a camera and 3 separate instruments, with fully wristed motions, to be placed through a single 25 mm port. This system was designed to perform complex surgery in narrow deep spaces making it very suitable for complex urinary tract reconstruction surgery. This paper will describe our early experience of using the SP system for several types of urinary reconstruction procedures and will present our lessons learned, surgical philosophy to using the SP and early data. As with all new technologies, there is an associated learning curve and nuances to be discovered and overcome. Methods The da Vinici SP™ surgical system was acquired and delivered to at our institution in January 2019. Five high volume robotic urologic surgeons at our institutions underwent certification with the da Vinci SP™ and have been adding this technology into their armamentarium. Almost all cases were recorded for quality improvement initiatives and evaluated with the goal of creating standard operating procedures in terms of access, steps of procedure and minimizing pit falls. Data from all patients undergoing SP urinary tract reconstruction that were entered into our prospective institutional database were reported. Results From 1/2019 to 8/2019 we have performed 71 urologic SP cases with the SP of which 18 were for urinary tract reconstructive procedures. These cases included 15 pyeloplasties, 1 buccal mucosa ureteroplasty, 1 ureteral implant and 1 repair of vesico-vaginal fistula. This paper outlines our standard operating procedures for table positioning, port placement, access and surgical steps for these complex SP cases. Our early data suggests that use of the SP system for urinary reconstruction is safe and reproducible. Conclusions The SP robotic surgical system has the potential to be used for nearly all robotic urologic reconstructive procedures. Advantages include a superior cosmetic result and ability to access all surgical quadrants without re-docking or repositioning. Limitations include no near infrared fluorescence imaging, smaller working space and slightly increased difficulty with retraction. We believe these obstacles will be overcome with time and experience. The da Vinci SP™ surgical system, in our initial experience, appears to be as safe and effective as its multiport counterpart for reconstructive surgeries.
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Affiliation(s)
- Mubashir Shabil Billah
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Ravi Munver
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Johnson Tsui
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Gregory Lovallo
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
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Song WH, Baik J, Yang S, Choi EK, Park SM, Jeong CW. Animal model evaluation of a novel renal denervation system for future laparoscopic treatment of resistant hypertension. Investig Clin Urol 2020; 61:107-113. [PMID: 31942470 PMCID: PMC6946818 DOI: 10.4111/icu.2020.61.1.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/13/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Although percutaneous catheter-based ablation of renal sympathetic nerve fibers has been used in the treatment of patients with resistant hypertension, a recent phase III study did not confirm its efficacy. In this study, we developed a novel laparoscopic renal denervation system and evaluated its safety and initial feasibility using an animal model. Materials and Methods A novel surgical instrument that uses a smart algorithm with temperature-monitoring feedback was developed. We used 4 male pigs (6 weeks old, weighing approximately 45 kg each) to evaluate the safety and efficacy of the laparoscopic renal denervation system. We performed immunohistochemical staining analysis after renal denervation using various tip temperatures and over various durations through an open approach. Results When the temperature of the outer wall of the renal artery was maintained at 90℃ for 180 seconds, the artery was completely denervated without damaging its inner layer, as evaluated using Masson's trichrome staining. When the temperature ranged from 70℃ to 90℃ and the duration ranged from 90 to 420 seconds, partial or complete denervation without significant vessel injury was confirmed with anti- growth-associated protein 43 and anti-S100 staining. Conclusions This animal study confirmed the safety and feasibility of the novel laparoscopic renal denervation system. A safe and effective protocol was developed with ablation at a constant tissue temperature of 70℃ to 90℃ within 180 seconds. However, further developments are necessary before its clinical use.
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Affiliation(s)
- Won Hoon Song
- Department of Urology, Seoul National University Hospital, Seoul, Korea.,Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jinhwan Baik
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Sunchoel Yang
- Department of Prototype Production, Osong Medical Innovation Foundation, Cheongju, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung-Min Park
- Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Heo JE, Kang SK, Koh DH, Na JC, Lee YS, Han WK, Choi YD, Jang WS. Pure single-site robot-assisted pyeloplasty with the da Vinci SP surgical system: Initial experience. Investig Clin Urol 2019; 60:326-330. [PMID: 31294143 PMCID: PMC6607072 DOI: 10.4111/icu.2019.60.4.326] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/19/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose Laparoendoscopic single-site surgery (LESS) reduces the limited invasiveness of conventional laparoscopy while providing superior cosmetic results. However, LESS remains a challenging surgical technique, even in robotic surgery, primarily due to the lack of triangulation and limited instrument movement. The da Vinci SP surgical system (Intuitive Surgical) was recently introduced to overcome these limitations. We describe our initial experience with pure single-site robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction (UPJO) using the da Vinci SP surgical system. Materials and Methods Three consecutive patients who were diagnosed with UPJO underwent RAP with the da Vinci SP surgical system from December 2018 to February 2019 at our institution. The surgical technique involved reproducing the steps of multi-port RAP. A 30-mm umbilical incision was made and the GelPOINT was inserted. The multichannel robotic port and the assistant's port were placed through the GelSeal cap. In all patients, Anderson–Hynes dismembered pyeloplasty was performed. The ureteral double J stent was inserted antegrade, and the drain was not placed. Results The procedures were successfully completed using a pure single-site approach. There was no need for additional port placement or conversion to laparoscopic or open surgery. Total operative time in the three patients was 139, 180, and 213 minutes, respectively. No intraoperative complications occurred, and blood loss was minimal. The postoperative course of all patients was uneventful with no complications greater than Clavien–Dindo grade I surgical complications. Conclusions Pure single-site RAP using the da Vinci SP surgical system is feasible and safe.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ku Kang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Koh
- Department of Urology, Konyang University College of Medicine, Daejeon, Korea
| | - Joon Chae Na
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seung Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Alshiek J, Bar-El L, Shobeiri SA. Vaginal Robotic Supracervical Hysterectomy in an Ovine Animal Model: The Proof of Concept. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojog.2019.98108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chang Y, Lu X, Zhu Q, Xu C, Sun Y, Ren S. Single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP): Initial experience. Asian J Urol 2018; 6:294-297. [PMID: 31297322 PMCID: PMC6595143 DOI: 10.1016/j.ajur.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP) and discuss its surgical technique. Methods A 60-year-old male was admitted with an elevated prostate-specific antigen (PSA) level of 13.89 ng/mL and confirmed with prostate cancer on biopsy showing three of 22 positive cores with a Gleason score of 3 + 4 = 7. Multiparametric magnetic resonance (MR) and bone scintigraphy showed organ-confined disease. spRALP was performed using da Vinci Si HD surgical system, with access of a quadri-channel laparoscopic port placed supraumbilically. Two drainage tubes were placed before wound closure. The surgical procedure was largely in consistence with a conventional robotic-assisted laparoscopic radical prostatectomy. Results The surgery was successfully carried out with a duration of 152 min and an estimated blood loss of 100 mL. The patient was discharged on postoperative Day 4 after removal of both pelvic drainage tubes. Foley catheter was removed on postoperative Day 14. No major complications were encountered. Postoperative pathology showed a Gleason score of 3 + 4 = 7 with no extraprostatic extension and negative surgical margins. Conclusion Single-port robotic prostatectomy is feasible using the currently available robotic instruments in most Chinese robotic urological centers. Meticulous preoperative planning and careful patient selection are mandatory. Further studies concerning perioperative complications and pentafecta outcome compared with the conventional multi-port robotic prostatectomy is required.
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Affiliation(s)
- Yifan Chang
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
| | - Xiaojun Lu
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
| | - Qingliang Zhu
- Department of Urology, Jiangdu People's Hospital, Yangzhou, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
- Corresponding authors.
| | - Shancheng Ren
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
- Corresponding authors.
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Gettman MT. Editorial Comment on: The Decline of Laparoendoscopic Single-Site Surgery: A Survey of the Endourological Society to Identify Shortcomings and Guidance for Future Directions by Sorokin et al. (From: Sorokin I, Canvasser NE, Irwin B, et al. J Endourol 2017;31:1049-1055). J Endourol 2017; 31:1343-1344. [PMID: 29048229 DOI: 10.1089/end.2017.0688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform. J Robot Surg 2017; 12:381-385. [DOI: 10.1007/s11701-017-0724-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
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Yanishi M, Kinoshita H, Mishima T, Taniguchi H, Yoshida K, Komai Y, Yasuda K, Watanabe M, Sugi M, Matsuda T. Influence of scars on body image consciousness with respect to gender following laparoendoscopic single-site versus conventional laparoscopic surgery. Scand J Urol 2016; 51:57-61. [PMID: 27834569 DOI: 10.1080/21681805.2016.1250811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate and compare the cosmetic outcomes of laparoscopic single-site surgery (LESS) and conventional laparoscopy (CL) in the treatment of ureteropelvic junction obstruction (UPJO) and urachal remnant removal. LESS is thought to produce better cosmetic results than CL; however, patients' perception of their scars has not been assessed. This study compared the subjective body image and cosmesis ratings of patients who had undergone LESS or CL for UPJO and urachal remnant removal. MATERIALS AND METHODS Fifty patients who underwent LESS or CL for UPJO or urachal remnant removal between June 2008 and June 2015 were included. Cosmetic outcomes were evaluated using the Body Image Questionnaire (BIQ) and Photo-Series Questionnaire (PSQ). RESULTS The body image and cosmetic scores were significantly higher for patients who underwent LESS than for those who underwent CL, for both pyeloplasty and urachal remnant removal (p < .05 each). When performed for either a pyeloplasty or urachal remnant removal, significantly greater BIQ and PSQ scores were observed in females after LESS compared to CL, but not in males. CONCLUSION LESS for UPJO and urachal remnant removal has better self-reported body image and cosmesis ratings than CL. This trend is particularly strong in female patients.
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Affiliation(s)
- Masaaki Yanishi
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Hidefumi Kinoshita
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Takao Mishima
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Hisanori Taniguchi
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Kenji Yoshida
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Yoshihiro Komai
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Kaneki Yasuda
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Masato Watanabe
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Motohiko Sugi
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Tadashi Matsuda
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
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Wei D, Han Y, Li M, Wang Y, Chen Y, Luo Y, Jiang Y. Pure retroperitoneal natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy using standard laparoscopic instruments: a safety and feasibility study in a porcine model. BMC Urol 2016; 16:29. [PMID: 27286863 PMCID: PMC4902946 DOI: 10.1186/s12894-016-0145-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 05/31/2016] [Indexed: 11/23/2022] Open
Abstract
Background Among the different organs used for NOTES (natural orifice translumenal endoscopic surgery) technique, the transvaginal approach may be the optimal choice because of a simple and secure closure of colpotomy site. Pure and hybrid NOTES transvaginal operations were routinely performed via transperitoneal access. In this study, we investigate the safety and feasibility of pure retroperitoneal natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy using conventional laparoscopic techniques in a porcine model. Methods Six female pigs, weighing an average of 30 kg, were used in this study. Under general anesthesia, pure retroperitoneal NOTES transvaginal nephrectomy was conducted using standard laparoscopic instruments. Posterolateral colpotomy was performed, and the incision was enlarged laterally using blunt dissection and pneumatic dilation. A single-port device was inserted to construct the operative channel. The retroperitoneal space was created using sharp and blunt dissection under endoscopic guidance up to the level of the kidney. Dissection and removal of the kidney were performed according to standard surgical procedure, and the colpotomy site was closed using interrupted sutures. The survival and complications were observed 1 week postoperatively. Results Our results showed that two cases failed because of peritoneal rupture. One case was successful, but required the assistance of an extra 5 mm laparoscopic trocar inserted in the flank. Three cases of pure retroperitoneal NOTES transvaginal nephrectomy were completed, and survived 1 week after the operation. In these three cases, no intra- or postoperative complications were observed. Conclusions All findings confirmed the safety and feasibility of the retroperitoneal pure retroperitoneal NOTES transvaginal nephrectomy using standard laparoscopic instruments, which suggested the possibility of clinical application in human beings in the future.
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Affiliation(s)
- Dechao Wei
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Yili Han
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Mingchuan Li
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Yongxing Wang
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Yatong Chen
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Yong Luo
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Yongguang Jiang
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China.
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Angulo JC, Pérez S, García-Tello A, Redondo C, Meilán E, Arance I. Two-Port Laparoscopic Reconstructive Surgery of the Urinary Tract with Reusable Umbilical System (Hybrid Less): A Proof of Concept Study. Urol Int 2016; 97:179-85. [PMID: 26930218 DOI: 10.1159/000444419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We compared perioperative results and complications of reconstructive surgery of the urinary tract performed using a multichannel platform through the umbilicus and one additional 3.5-mm with a cohort of patients simultaneously treated with conventional 4-port laparoscopy. MATERIALS AND METHODS Matched-pair study comparing perioperative outcomes, postoperative visual analogue pain scale (VAPS) and morbidity of 2-port (n = 20) and 4-port (n = 10) laparoscopic reconstructive urological surgery. Preoperative and perioperative data compared included demographics, type of surgery, operative time, blood loss, decrease in serum hemoglobin, operative complications, length of stay and postoperative complications according to Clavien-Dindo classification. RESULTS There was no significant difference between groups regarding age, gender, body mass index, American Society of Anesthesiologists score, type of surgery, operative time, operative complications and intraoperative or postoperative transfusion. Estimated blood loss was lower using reduced-port approach. VAPS at postoperative day one was significantly lower for 2-port approach and so was the length of stay. Patient satisfaction with the wound was higher for 2-port surgery. Differences were not observed in number and severity of postoperative complications. CONCLUSIONS Urological reconstructive operations can be safely performed using the hybrid laparoendoscopic single-site umbilical approach, resulting in lower blood loss, higher patient satisfaction and lower postoperative pain, which also facilitate earlier hospital discharge, than the same reconstructive procedures performed through multiport conventional laparoscopy.
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Affiliation(s)
- Javier C Angulo
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, Madrid, Spain
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Kim DK, Yoon YE, Han WK, Rha KH. Roles of NOTES and LESS in management of small renal masses. Int J Surg 2015; 36:574-582. [PMID: 26607854 DOI: 10.1016/j.ijsu.2015.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/27/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Over the last 2 decades, open surgery has been largely displaced by laparoscopic surgery for the treatment of renal masses. Recently, minimally invasive surgical techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), have been developed for such purpose. METHODS In the present literature review, the current status of treatment for small renal masses was investigated. The advantages and disadvantages of LESS and NOTES are presented to confirm the feasibility and reproducibility of these techniques. RESULTS LESS significantly reduces pain and offers excellent cosmetic outcomes with comparable oncological and perioperative results, and NOTES offers the potential for surgery by various approach without any transcutaneous abdominal incision in management of small renal masses. CONCLUSION When the technical limitations are overcome, clinical application of LESS and NOTES is expected to increase. Further prospective and comparative studies are needed to clarify the application of these new techniques.
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Affiliation(s)
- Dae Keun Kim
- Department of Urology, CHA Gangnam Hospital, CHA University, CHA Medical School, Seoul, Republic of Korea; Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul, Republic of Korea.
| | - Young Eun Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
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Akça O, Zargar H, Autorino R, Brandao LF, Gürler AS, Avşar A, Horuz R, Albayrak S. The transrectal single port laparoscopic radical prostatectomy in a cadaver model. Turk J Urol 2015; 41:78-82. [PMID: 26328206 DOI: 10.5152/tud.2015.40336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/03/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. MATERIALS AND METHODS After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT(®)Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT(®)Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. RESULTS Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. CONCLUSION Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.
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Affiliation(s)
- Oktay Akça
- Department of Urology, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Homayoun Zargar
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Riccardo Autorino
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Luis Felipe Brandao
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Ahmet Selçuk Gürler
- T.C. Ministry of Justice, Turkish Council of Forensic Medicine, İstanbul, Turkey
| | - Abdullah Avşar
- T.C. Ministry of Justice, Turkish Council of Forensic Medicine, İstanbul, Turkey
| | - Rahim Horuz
- Department of Urology, Medipol University Hospital, İstanbul, Turkey
| | - Selami Albayrak
- Department of Urology, Medipol University Hospital, İstanbul, Turkey
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Hirano D, Hasegawa R, Igarashi T, Satoh K, Mochida J, Takahashi S, Yoshida T, Saitoh T, Kiyotaki S, Okada K. Laparoscopic adrenalectomy for adrenal tumors: A 21-year single-institution experience. Asian J Surg 2015; 38:79-84. [DOI: 10.1016/j.asjsur.2014.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 01/17/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022] Open
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Buffi NM, Lughezzani G, Fossati N, Lazzeri M, Guazzoni G, Lista G, Larcher A, Abrate A, Fiori C, Cestari A, Porpiglia F. Robot-assisted, Single-site, Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction with the New da Vinci Platform: A Stage 2a Study. Eur Urol 2015; 67:151-156. [DOI: 10.1016/j.eururo.2014.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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Azizi Koutenaei B, Wilson E, Monfaredi R, Peters C, Kronreif G, Cleary K. Robotic natural orifice transluminal endoscopic surgery (R-NOTES): Literature review and prototype system. MINIM INVASIV THER 2014; 24:18-23. [DOI: 10.3109/13645706.2014.992907] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Glauser PM, Käser SA, Berov S, Walensi M, Kuhnt E, Maurer CA. Enlargement of umbilical incision in standard laparoscopic cholecystectomy is frequently necessary: An argument for the single incision approach? MINIM INVASIV THER 2014; 24:175-80. [PMID: 25400218 DOI: 10.3109/13645706.2014.980430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Cosmetic result after cholecystectomy is up for debate. The aim of this study was to investigate the incidence and extent of enlargement of initial skin and fascia incision in standard laparoscopic cholecystectomy and to detect predictive factors for such an enlargement. MATERIAL AND METHODS The size of the umbilical incision was measured before and after standard laparoscopic gallbladder removal in 391 patients from August 2009 to October 2012. Predisposing factors for the need of enlargement of the umbilical incision were analysed. RESULTS Additional enlargement of the umbilical incision for gallbladder removal was required in 35.8% of the patients at skin level, and in 40.4% at fascia level. The median enlargement of the umbilical skin incision was 11 mm, from 25 mm to 36 mm. Gallbladder weight, total stone weight, maximum diameter of largest stone and shorter initial length of incision were independent predisposing factors for enlargement of the incision. CONCLUSIONS In standard laparoscopic cholecystectomy the umbilical incision frequently requires secondary enlargement, especially if a large stone mass is involved. Therefore, the cosmetic result after laparoscopic cholecystectomy depends on more than only the technique used for access and the surgical technique for cholecystectomy should be chosen individually for each patient according to the stone mass.
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Hu D, Wang X, Hu W. Modified retroperitoneoscopic port sites for surgery of upper urinary tract. JSLS 2014; 18:JSLS-D-13-00206. [PMID: 25392615 PMCID: PMC4154405 DOI: 10.4293/jsls.2014.00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our objective was to introduce our experience using modified retroperitoneoscopic port positions for operations of the upper urinary tract. METHODS We designed different trocar positions or incisions according to different surgical procedures and specimen sizes. A total of 116 patients, comprising patients with common adrenal, kidney, and ureter diseases, underwent retroperitoneoscopic operations by use of modified incisions. These patients comprised 23 with adrenal diseases, 84 with kidney diseases, and 9 with ureter diseases. The specimen was retrieved, as much as possible, through a transverse incision to produce a hidden scar after recovery. By contrast, 143 patients underwent the same or similar procedures using classical 3-port incisions. The operative time was defined as the time from skin incision to skin closure. RESULTS There were no significant differences in age, estimated blood loss, oral intake, and hospital stay between groups. A significant difference in favor of the modified group was noted with respect to analgesia use (diclofenac sodium, 50 mg vs 100 mg; P<.05) in all 3 modified methods, as well as in cosmetic outcome in the groups undergoing the first modification (score, 8.9±2.2 VS 7.3±2.8; P<.05) and second modification (score, 8.7±2.5 VS 7.1±2.4; P<.05). In addition, the mean operative time in patients undergoing ureter operations was shorter than that in the conventional group using classical 3-port positions (55±11 minutes vs 70±15 minutes, P<.05). CONCLUSIONS Our modified retroperitoneoscopic incision is a safe, cosmetic alternative procedure for operations of the upper urinary tract. Different diseases and specimen sizes can be treated with the personalized or suitable incisions that we have introduced.
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Affiliation(s)
- Dongliang Hu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wanli Hu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Gracia M, Sisó C, Martínez-Zamora MÀ, Sarmiento L, Lozano F, Arias MT, Beltrán J, Balasch J, Carmona F. Immune and Stress Mediators in Response to Bilateral Adnexectomy: Comparison of Single-Port Access and Conventional Laparoscopy in a Porcine Model. J Minim Invasive Gynecol 2014; 21:837-43. [DOI: 10.1016/j.jmig.2014.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/15/2014] [Accepted: 03/18/2014] [Indexed: 11/24/2022]
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Shin TY, Lim SK, Komninos C, Kim DW, Han WK, Hong SJ, Jung BH, Rha KH. Laparoendoscopic single-site (LESS) robot-assisted partial nephrectomy (RAPN) reduces postoperative wound pain without a rise in complication rates. BJU Int 2014; 114:555-61. [DOI: 10.1111/bju.12783] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tae Young Shin
- Department of Urology; Chuncheon Sacred Hospital; Hallym University College of Medecine; Chuncheon Korea
| | - Sey Kiat Lim
- Department of Urology; Changi General Hospital; Singapore
| | - Christos Komninos
- Department of Urology; General Hospital of Nikaia ‘St. Panteleimon’; Athens Greece
| | - Dong Wook Kim
- Biostatistics Collaboration Unit; Yonsei University College of Medicine; Seoul Korea
| | - Woong Kyu Han
- Department of Urology; Urological Science Institute; Seoul Korea
| | - Sung Jun Hong
- Department of Urology; Urological Science Institute; Seoul Korea
| | - Byung Ha Jung
- Department of Urology; Urological Science Institute; Seoul Korea
| | - Koon Ho Rha
- Department of Urology; Urological Science Institute; Seoul Korea
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Fransen SA, Broeders E, Stassen L, Bouvy N. The voice of Holland: Dutch public and patient's opinion favours single-port laparoscopy. J Minim Access Surg 2014; 10:119-25. [PMID: 25013327 PMCID: PMC4083543 DOI: 10.4103/0972-9941.134874] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/26/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION: Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy. MATERIALS AND METHODS: An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years) were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy. RESULTS: A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population. CONCLUSION: Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for the safety and feasibility of this new surgical technique needs to be obtained before this procedure can be implemented into everyday practice.
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Affiliation(s)
- Sofie Af Fransen
- Department of Surgery, Atrium Medical Centre Heerlen, The Netherlands ; Maastricht University Medical Centre, The Netherlands
| | - Epm Broeders
- Maastricht University Medical Centre, The Netherlands
| | - Lps Stassen
- Maastricht University Medical Centre, The Netherlands
| | - Nd Bouvy
- Maastricht University Medical Centre, The Netherlands
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Zou X, Zhang G, Xue Y, Yuan Y, Xiao R, Wu G, Wang X, Wu Y, Long D, Yang J, Xu H, Liu F, Liu M. Transumbilical multiport laparoscopic nephrectomy with specimen extraction through the vagina. Urol Int 2014; 92:407-13. [PMID: 24732939 DOI: 10.1159/000356099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 09/30/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To report our initial experience with transumbilical multiport laparoscopic nephrectomy (TMLN) with transvaginal specimen extraction. PATIENTS AND METHODS Between January and July 2010, 5 married and parous female patients were submitted to TMLN with transvaginal specimen extraction in our center. All data referring to patient demographics, surgery, pathology and perioperative outcomes were recorded. Sexual function was assessed with the Female Sexual Function Index questionnaire before and after surgery. The cosmetic result was investigated by administering the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS All procedures were completed successfully. The mean operative time was 136 min (range 110-160 min, standard deviation [SD] 20.7). The mean estimated blood loss was 66 ml (range 40-100 ml, SD 24.1). The mean postoperative hospitalization stay was 4.8 days (range 4-6 days, SD 0.8). All patients reported unaltered sexual function after surgery. The better cosmetic results were confirmed by the PSAQ score. CONCLUSIONS TMLN with transvaginal specimen extraction is feasible and safe for married and parous female patients. This technique is a natural evolution towards natural orifice transluminal endoscopic surgery (NOTES). By acting as an intermediate-type procedure, it provides a bridge through which NOTES may ultimately gain clinical acceptance.
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Affiliation(s)
- Xiaofeng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
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Naitoh Y, Kawauchi A, Yamada Y, Fujihara A, Hongo F, Kamoi K, Okihara K, Miki T. Laparoendoscopic single-site versus conventional laparoscopic pyeloplasty: a matched pair analysis. Int J Urol 2014; 21:793-6. [PMID: 24665832 DOI: 10.1111/iju.12427] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/04/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare the outcomes of laparoendoscopic single-site pyeloplasty versus those of conventional laparoscopic pyeloplasty. METHODS A total of 26 laparoendoscopic single-site pyeloplasty cases carried out in University Hospital: Kyoto Prefectural University of Medicine, Kyoto, Japan, from 2008 to 2013 were compared with a control group of 26 age-matched laparoscopic pyeloplasty cases carried out during the same study period. RESULTS The mean age of the patients was 20.4 years (range 1-56 years). Laparoendoscopic single-site pyeloplasty was carried out on the right in nine cases and on the left in 17 cases. The operative time was 246 ± 68 min. Regarding the 14 pediatric patients, the mean age was 7.1 years (range 1-14 years). The operative time was 243 ± 49 min. As for the 12 adult patients, the mean age was 35.8 years (range 16-56 years). The operative time was 248 ± 86 min. The mean operative time of the control group in age-matched laparoscopic pyeloplasty was 239 ± 51 min. Times were 229 ± 54 min for the pediatric patients and 253 ± 45 min for the adult patients. There was no significant difference in the operative time between the control group and the laparoendoscopic single-site group for both adults and children. Blood loss was minimal, and no intraoperative and postoperative complications were observed in the 26 laparoendoscopic single-site pyeloplasty cases. CONCLUSION The present findings suggest that laparoendoscopic single-site pyeloplasty can be used in both pediatric and adult patients, offering a superior cosmetic outcome than conventional laparoscopic pyeloplasty, and a lower degree of postoperative pain. A large-scale prospective, randomized study is required to confirm these findings, and to define the future role of laparoendoscopic single-site pyeloplasty.
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Affiliation(s)
- Yasuyuki Naitoh
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Tiu A, Shin TY, Kim KH, Lim SK, Han WK, Rha KH. Robotic laparoendoscopic single-site transumbilical partial nephrectomy: functional and oncologic outcomes at 2 years. Urology 2013; 82:595-9. [PMID: 23890663 DOI: 10.1016/j.urology.2013.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/26/2013] [Accepted: 05/05/2013] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To assess the functional and oncologic outcomes of robotic laparoendoscopic single site surgery (LESS) partial nephrectomy with a minimum of 2-year follow-up. MATERIALS AND METHODS Thirty-nine consecutive patients who had undergone robotic LESS partial nephrectomy were identified with a minimum of 2-year follow-up. Perioperative data were recorded along with functional and oncologic outcomes. Patient's estimated glomerular filtration rate was determined using the Modification of Diet in Renal Disease formula. A univariate analysis was performed using independent samples t test. Data are presented as medians with interquartile range and counts or frequencies with percentages or proportion. RESULTS The median age was 51 (45, 59). The median resected tumor size was 3 cm (2, 3.7), and the median operative time was 185 minutes (135, 237). The median estimated blood loss was 150 mL (70, 150), and the median warm ischemia time was 25 minutes (17, 35). The estimated glomerular filtration rate did not change significantly at 24 month follow-up with a mean decrease of 6.4 mL/minute/1.73 m(2) (-7.5%, P = .22). Renal cell carcinoma was confirmed in 33 patients (85%) with tumor stage pT1a in 26 patients (78%). There was 1 patient with a positive surgical margin. At a median follow-up of 26 months (24, 32), there was no local recurrence and only 1 distant recurrence was detected. CONCLUSION This study appears to be the first to report on intermediate term functional and oncologic outcomes after robotic LESS partial nephrectomy. It has shown comparable results with other minimal invasive surgical options.
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Affiliation(s)
- Albert Tiu
- Urological Society of Australia and New Zealand, Edgecliff, New South Wales, Australia
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Kim SD, Landman J, Sung GT. Laparoendoscopic single-site surgery with the second-generation single port instrument delivery extended reach surgical system in a porcine model. Korean J Urol 2013; 54:327-32. [PMID: 23700499 PMCID: PMC3659227 DOI: 10.4111/kju.2013.54.5.327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/18/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe our initial experience with the second-generation Single Port Instrument Delivery Extended Reach (SPIDER) laparoendoscopic single-site surgical system in a porcine model. Materials and Methods In four swine weighing approximately 32 to 35 kg, five nephrectomies, four adrenalectomies, three pyeloplasties, and three partial cystectomies and closures were performed by a single surgeon. The swine were placed in the lateral flank position under general anesthesia. The SPIDER surgical system was introduced through a single incision and the various urological procures were performed by use of flexible instrumentation. Results All five nephrectomies, four adrenalectomies, three pyeloplasties, and three partial cystectomies and closures were performed successfully without additional skin incisions. The mean time to set up the SPIDER platform was 3.5 minutes. The mean operative time for the right and left nephrectomies was 45.4 minutes and 47.8 minutes, respectively. The mean operative time for the right and left adrenalectomies was 37.6 minutes and 35.4 minutes, respectively. The mean operative time for the pyeloplasties for one right and two left ureters was 45.6 minutes and 47.3 minutes, respectively. The mean operative time for the partial cystectomies and closures was 18.6 minutes. There were no noticeable intraoperative complications except for minimal urine leakage in the first pyeloplasty. Conclusions In this initial pilot evaluation, the second-generation SPIDER surgical system offered intuitive instrument maneuverability and restored triangulation. However, retraction was challenging because of the lack of strength and the limited ability for precise manipulation of the tip. Future refinements of the technology and prospective studies are needed to optimize the application of this technology in urology.
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Affiliation(s)
- Soo Dong Kim
- Department of Urology, Dong-A Medical Center, Busan, Korea
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Abstract
BACKGROUND Our novel approach is a hybrid between cylindrical abdominoperineal resection and single-incision laparoscopic surgery (SILS). We report the clinical application of this technique and present preliminary data that shows this approach to be an effective tool for resection of low rectal cancer. METHODS Twenty patients with endoscopy-considered and biopsy-proven malignant lesions were required to undergo abdominal computed tomography examination for determining tumor stage. In addition, all patients had taken in digital rectal examination again on the surgery day. Perioperative management of patients was executed according to management of patients in fast-track surgery. First, cylindrical abdominoperineal resection was performed with the patients in the prone jackknife position to peritoneal reflection, then we turned the patients to the supine position and SILS was performed with the homemade single-port device. RESULTS The average distance from the anal verge was 2.60±1.14 cm and the mean tumor diameter confirmed by pathology measured to be 3.00±1.08 cm, and the circumferential margin was negative in all the specimens. The mean fabrication and set-up time of the homemade SILS device was 7.75±1.21 minutes and the average operating time was 138.55±9.32 minutes with minimal blood loss (20.5±5.83 mL). There were no conversions from SILS to conventional laparoscopy. On average, oral intake can often be successfully initiated 7.35±1.35 h after surgery, with the first passage of flatus from the colostomy occurring 2.55±0.76 d postoperation. Function hospital stay was 4.25±0.97 d with no undue sequelae. During the 6-month-long follow-up stage, no morbidity or mortality was observed except in 2 patients with poor union in perineum incision. CONCLUSIONS Cylindrical abdominoperineal decection combined with SILS is a feasible alternative for low rectal cancer, providing benefits like leaving enough exposure for operation, reducing trauma to surrounding organs, almost completely avoiding circumferential involvement, and allowing fast postoperative recovery.
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Wang L, Wu Z, Li M, Cai C, Liu B, Yang Q, Sun Y. Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies. J Endourol 2013; 27:743-50. [PMID: 23611672 DOI: 10.1089/end.2012.0599] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the surgical efficacy and potential advantages of laparoendoscopic single-site adrenalectomy (LESS-AD) compared with conventional laparoscopic adrenalectomy (CL-AD) based on published literature. METHODS An online systematic search in electronic databasesM including Pubmed, Embase, and the Cochrane Library, as well as manual bibliography searches were performed. All studies that compared LESS-AD with CL-AD were included. The outcome measures were the patient demographics, tumor size, blood loss, operative time, time to resumption of oral intake, hospital stay, postoperative pain, cosmesis satisfaction score, rates of complication, conversion, and transfusion. A meta-analysis of the results was conducted. RESULTS A total of 443 patients were included: 171 patients in the LESS-AD group and 272 patients in the CL-AD group (nine studies). There was no significant difference between the two groups in any of the demographic parameters expect for lesion size (age: P=0.24; sex: P=0.35; body mass index: P=0.79; laterality: P=0.76; size: P=0.002). There was no significant difference in estimated blood loss, time to oral intake resumption, and length of stay between the two groups. The LESS-AD patients had a significantly lower postoperative visual analog pain score compared with the CL-AD group, but a longer operative time was noted. Both groups had a comparable cosmetic satisfaction score. The two groups had a comparable rate of complication, conversion, and transfusion. CONCLUSIONS In early experience, LESS-AD appears to be a safe and feasible alternative to its conventional laparoscopic counterpart with decreased postoperative pain noted, albeit with a longer operative time. As a promising and emerging minimally invasive technique, however, the current evidence has not verified other potential advantages (ie, cosmesis, recovery time, convalescence, port-related complications, etc.) of LESS-AD.
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Affiliation(s)
- Linhui Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, PR China
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Seo IY, Rim JS. Laparoendoscopic single-site pyelolithotomy with use of a carter-thomason needle grasper. Korean J Urol 2013; 54:163-7. [PMID: 23526200 PMCID: PMC3604568 DOI: 10.4111/kju.2013.54.3.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 01/27/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To study the feasibility and safety of the procedure, we present our early experience with laparoendoscopic single-site (LESS) pyelolithotomy performed by use of a Carter-Thomason needle grasper. MATERIALS AND METHODS Four patients underwent LESS pyelolithotomy for the removal of renal pelvic stones. The patients' mean age was 57.8 years, and their mean body mass index was 23.01. We used a homemade single-port device made with a surgical glove that was inserted into a 2.5-cm periumbilical incision. The operation was performed transperitoneally by using a Carter-Thomason grasper. After removal of the stone, a double-J stent was placed in situ, and laparoscopic intracorporeal suturing was performed. No additional ports were used. RESULTS All surgeries were completed successfully without conversion to conventional laparoscopy or open surgery. The mean operative time was 124.5 minutes, and the mean estimated blood loss was 255.2 mL. There were no significant complications, except in one patient who required a blood transfusion. The mean duration of hospital stay was 8.3 days. The mean stone size was 3.9 cm. Chemical analysis of the stones showed that three patients had calcium-containing stones and one patient had a uric acid stone. Postoperative radiologic study showed a stone clearance rate of 100%. CONCLUSIONS Our results, albeit limited, showed that LESS pyelolithotomy is a feasible and safe procedure. Especially with the use of a Carter-Thomason needle grasper, this operation can be performed without an additional port.
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Affiliation(s)
- Ill Young Seo
- Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine & Hospital, Iksan, Korea
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Autorino R, Yakoubi R, White WM, Gettman M, De Sio M, Quattrone C, Di Palma C, Izzo A, Correia-Pinto J, Kaouk JH, Lima E. Natural orifice transluminal endoscopic surgery (NOTES): where are we going? A bibliometric assessment. BJU Int 2013; 111:11-6. [PMID: 23323699 DOI: 10.1111/j.1464-410x.2012.11494.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this study was to analyse natural orifice transluminal endoscopic surgery (NOTES)-related publications over the last 5 years. A systematic literature search was done to retrieve publications related to NOTES from 2006 to 2011. The following variables were recorded: year of publication; article type; study design; setting; Journal Citation Reports® journal category; authors area of surgical speciality; geographic area of origin; surgical procedure; NOTES technique; NOTES access route; number of clinical cases. A time-trend analysis was performed by comparing early (2006-2008) and late (2009-2011) study periods. Overall, 644 publications were included in the analysis and most papers were found in general surgery journals (50.9%). Studies were most frequently clinical series (43.9%) and animal experimental (48%), with the articles focusing primarily on cholecystectomy, access creation and closure, and peritoneoscopy. Pure NOTES techniques were performed in most of the published reports (85%) with the remaining cases being hybrid NOTES (7.4%) and NOTES-assisted procedures (6.1%). The access routes included transgastric (52.5%), transcolonic (12.3%), transvesical (12.5%), transvaginal (10.5%), and combined (12.3%). From the early to the late period, there was a significant increase in the number of randomised controlled trials (5.6% vs 7.2%) or non-randomised but comparative studies (5.6% vs 22.9%) (P < 0.001) and there was also a significant increase in the number of colorectal procedures and nephrectomies (P = 0.002). Pure NOTES remained the most studied approach over the years but with increased investigation in the field of NOTES-assisted techniques (P = 0.001). There was also a significant increase in the adoption of transvesical access (7% vs 15.6%) (P = 0.007). NOTES is in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. Since the first description of the concept of NOTES, >2000 clinical cases, irrespective of specialty, have been reported. NOTES remains a field of intense clinical and experimental research in various surgical specialities.
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Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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García-Mediero JM, Cabrera PM, Cáceres F, Mateo E, García-Tello A, Angulo JC. [Current state of single-port transumbilical surgery in urology: challenges and applications]. Actas Urol Esp 2013; 37:106-13. [PMID: 22999345 DOI: 10.1016/j.acuro.2012.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/20/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT Laparoscopic surgery in urology is considered to be an important advance, although it is not exempt from some morbidity associated to the use of multiple trocars and specifically to the extraction of the specimen. In order to decrease this morbidity and improve esthetics, other techniques are being developed, such as natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). It is aimed to review the current status of laparoendoscopic single site surgery in urology. ACQUISITION OF EVIDENCE A nonsystematic review has been carried out by means of the bibliographic search using the terms LESS and Urology from 2007 to 2012. The current LESS experience in urology is described, and its principal indications and the different single site devices and instruments available on the market are described. SYNTHESIS OF EVIDENCE LESS surgery arose as one more step in the constant evolution of minimally invasive surgery in an attempt to improve esthetics, reduce surgical trauma and decrease pain and the post-operative complications associated to the conventional laparoscopy with multiple trocars. Since it was first described in 2007, the experience has been increasing exponentially and the LESS technique, whether assisted or not by robot, is becoming consolidated for a large spectrum of urological indications (both in oncological and reconstructive surgery) on a much greater scale than the NOTES technique. Even though most of the existing data are not randomized and very rarely comparative, with the selection bias that this represents, it seems clear that the esthetic benefit and analgesic control associated to the LESS surgery is real and reproducible. The complications associated to it are greater in cases of major oncology surgery and are due more to the technique itself then to the approach. CONCLUSIONS Although the real benefit of the LESS surgery in urology cannot be appropriately quantified, the cosmetic improvement, less pain and greater patient satisfaction with their wound are clear. Appropriate training in this type of procedures in centers having large volumes and the continuous technical improvements in the instrumental development by the biomedical industry has resulted in the fact that the transumbilical LESS technique in urology has been born to stay.
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Affiliation(s)
- J M García-Mediero
- Hospital Universitario de Getafe, Fundación para la Investigación Biomédica, Servicio Madrileño de Salud, Universidad Europea de Madrid, Madrid, España
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Wen SC, Yeh HC, Wu WJ, Chou YH, Huang CH, Li CC. Laparoendoscopic Single-Site Retroperitoneoscopic Adrenalectomy versus Conventional Retroperitoneoscopic Adrenalectomy: Initial Experience by the Same Laparoscopic Surgeon. Urol Int 2013; 91:297-303. [DOI: 10.1159/000351407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 04/16/2013] [Indexed: 11/19/2022]
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Tiu A, Kim KH, Shin TY, Han WK, Han SW, Rha KH. Feasibility of robotic laparoendoscopic single-site partial nephrectomy for renal tumors >4 cm. Eur Urol 2012; 63:941-6. [PMID: 23219087 DOI: 10.1016/j.eururo.2012.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/13/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoendoscopic single-site (LESS) urologic procedures have gained significant interest worldwide in an attempt to further reduce morbidity and minimize scarring associated with conventional laparoscopic surgery. The robotic technology has overcome some of the limitations of manual single-incision surgery relating to lack of triangulation, instrument collision, and surgical exposure. There are no data on robotic LESS partial nephrectomy (PN) for renal tumors >4 cm. OBJECTIVES To evaluate the feasibility of robotic LESS PN for renal tumors >4 cm. DESIGN, SETTING, AND PARTICIPANTS Data from 67 consecutive patients who underwent robotic LESS PN were collected between May 2009 to January 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were stratified into two groups: 20 patients with renal tumors >4 cm (group 1) and 47 patients with renal tumors ≤ 4 cm (group 2). Perioperative data were recorded and comparisons between the two groups were analyzed using the Mann-Whitney U test for continuous variables and Fisher exact test for categorical variables. RESULTS AND LIMITATIONS No statistically significant differences were found between the two groups in demographic information, operative complications, pathologic characteristics, mean decline in estimated glomerular filtration rate, estimated blood loss, operative times, conversion rate, or positive surgical margins. However, group 1 had a higher mean nephrometry score (p<0.01), longer warm ischemia time (p = 0.007), and longer length of stay (p = 0.046). Its retrospective design and being conducted at a single center were the main limitations of this study. CONCLUSIONS This study demonstrated the feasibility and safety of robotic LESS PN for tumors >4 cm. Patients with tumors >4 cm had a statistically significant, higher mean nephrometry score, longer warm ischemia time, and longer length of stay, but there was no increased risk of adverse outcomes. A long-term study is needed to confirm the durable renal preservation and oncologic outcomes for patients with larger tumor burden.
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Affiliation(s)
- Albert Tiu
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Bazzi WM, Raheem OA, Cohen SA, Derweesh IH. Natural orifice transluminal endoscopic surgery in urology: Review of the world literature. Urol Ann 2012; 4:1-5. [PMID: 22346092 PMCID: PMC3271442 DOI: 10.4103/0974-7796.91611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/14/2011] [Indexed: 12/12/2022] Open
Abstract
Natural orifice transluminal endoscopic surgery (NOTES) has gained momentum in the recent urologic literature as a new surgical approach for intra-abdominal organs with scarless and painless postoperative recoveries. We sought to review the published literature concerning the safety and reproducibility of NOTES in urology. PubMed literature review of articles published in the English language was performed over a 10-year period, i.e., between 2001 and 2011; all articles were critically reviewed and analyzed. Despite its novelty, pure or hybrid surgical approaches have been adapted in performing NOTES. NOTES essentially utilizes transluminal flexible endoscopic instruments along with laparoscopic instruments to gain access to abdominal, pelvic, and/or retroperitoneal cavities. The preliminary results of NOTES in surgery and to a limited extent in urology appear promising, yet further research in animal survival and human cadaveric models is requisite prior to human applications, especially for complex surgeries. Future innovative research, particularly biomedical engineering, should be directed to improving the technicality and mechanistic application of NOTES; hence, better safety and efficacy of NOTES.
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Affiliation(s)
- Wassim M Bazzi
- Department of Surgery, Division of Urology, University of California San Diego School of Medicine, La Jolla, San Diego, CA, USA
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Jeong CW, Lee SE, Kim HH. Re: Humphreys et al.: natural orifice transluminal endoscopic radical prostatectomy: initial perioperative and pathologic results (urology 2011;78:1211-1218). Urology 2012; 80:743-4; author reply 744-5. [PMID: 22925256 DOI: 10.1016/j.urology.2012.01.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 01/05/2012] [Accepted: 01/06/2012] [Indexed: 11/27/2022]
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Verit A, Rizkala E, Autorino R, Stein RJ. Robotic laparoendoscopic single-site surgery: From present to future. Indian J Urol 2012; 28:76-81. [PMID: 22557723 PMCID: PMC3339792 DOI: 10.4103/0970-1591.94962] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The continued effort of improving cosmesis and reducing morbidity in urologic surgery has given rise to novel alternatives to traditional minimally invasive techniques: Laparoendoscopic Single-site Surgery (LESS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES). Despite the development of specialized access devices and instruments, the performance of complex procedures using LESS has been challenging due to loss of triangulation and instrument clashing. A robotic interface may represent the key factor in overcoming the critical restrictions related to NOTES and LESS. Although encouraging, current clinical evidence related to R-LESS remains limited as the current da Vinci® robotic platform has not been specifically designed for LESS. Robotic innovations are imminent and are likely to govern major changes to the current landscape of scarless surgery.
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Affiliation(s)
- Ayhan Verit
- Harran University, Department of Urology, Sanliurfa, Turkey
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Evolution and simplified terminology of natural orifice transluminal endoscopic surgery (NOTES), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). World J Urol 2012; 30:573-80. [PMID: 22790450 DOI: 10.1007/s00345-012-0899-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/19/2012] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) are the next steps in the evolution of laparoscopic surgery, promising reduced morbidity and improved cosmetic result. The inconsistent terminology initially used led to confusion. Understanding the technical evolution, the current status and a unified and simplified terminology are key issues for further acceptance of both approaches. OBJECTIVE To present LESS and NOTES in its historical context and to clarify the associated terminology. METHOD Extensive literature search took place using the PubMed. Several hundred publications in general surgery and urology regarding LESS are present including the expert opinion of members the European Society of Uro-technology (ESUT). RESULTS The increasing interest on NOTES and LESS is reflected by a raising number of publications during the last 4 years. The initial confusion with the terminology of single-incision surgery represented a significant issue for further evolution of the technique. Thus, consortiums of experts searched a universally acceptable name for single-incision surgery. They determined that 'laparoendoscopic single-site surgery' (LESS) was both scientifically accurate and colloquially appropriate, the term being also ratified by the NOTES working group (Endourological Society) and the ESUT. For additional use of instruments, the terms hybrid NOTES and hybrid LESS should be used. Any single use of miniaturized instruments for laparoscopy should be called mini-laparoscopy. DISCUSSION The evolution of LESS and most likely NOTES to a new standard of minimally invasive surgery could represent an evolutionary step even greater than the one performed by the establishment of laparoscopy over open surgery.
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Cheung G, Dasgupta P, Guru KA, Billia M, Khan MS. Minimally invasive cystectomy approaches in the treatment of bladder cancer. Expert Rev Anticancer Ther 2012; 12:733-41. [PMID: 22716490 DOI: 10.1586/era.12.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bladder cancer is the most frequently occurring tumor of the urinary system, with over 10,000 new diagnoses each year in the UK. Approximately 70% of these are non-muscle-invasive and limited to the mucosa (Ta) or submucosa (T1). These tumors are generally managed with transurethral resection followed by adjuvant intravesical chemo- or immuno-therapy and regular cystoscopic surveillance. The principal end points in the management of these tumors are prevention of recurrence and progression. Muscle-invasive bladder cancer is a life-threatening disease with overall 5-year mortality of 50%. Neoadjuvant chemotherapy, where possible followed by radical surgery, is currently considered the best standard of care. Open radical cystectomy is the gold-standard treatment for muscle-invasive or high-risk non-muscle-invasive (multifocal or recurrence after intravesical therapy) bladder cancer. Historically, this procedure has carried significant morbidity, although mortality of open radical cystectomy has reduced to 1-2% owing to improvements in anesthesia and intensive care facilities. Over the last 15 years, minimally invasive techniques in radical cystectomy have evolved, with the aim of reducing morbidity. In this article, we review the development of laparoscopic radical cystectomy and robot-assisted radical cystectomy, along with current evidence on perioperative morbidity and medium-term oncological outcomes.
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Affiliation(s)
- Grace Cheung
- The Urology Center, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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Wang L, Liu B, Wu Z, Yang Q, Chen W, Sheng H, Xu Z, Xiao L, Wang C, Sun Y. Comparison of single-surgeon series of transperitoneal laparoendoscopic single-site surgery and standard laparoscopic adrenalectomy. Urology 2012; 79:577-83. [PMID: 22386401 DOI: 10.1016/j.urology.2011.09.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 09/12/2011] [Accepted: 09/20/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the feasibility, safety, and efficacy of transperitoneal laparoendoscopic single-site (LESS) adrenalectomy and determine whether it shows any objective advantage compared with standard laparoscopy. METHODS From August 2009 to May 2011, 13 transperitoneal LESS adrenalectomies were performed through a 2-3-cm skin incision using the TriPort access system. This cohort was compared with a contemporary 1:2 matched-pair group of 26 patients undergoing standard laparoscopic adrenalectomy by the same urologist. The perioperative outcomes, including cosmetic satisfaction scores, were statistically analyzed. RESULTS The 2 groups were comparable with respect to patient demographics, estimated blood loss, and postoperative hospitalization (P > .05). The LESS procedures had a longer mean operative time (148.5 vs 112.9 minutes, P = .032) but a significantly lower postoperative visual analog pain scale score (2.3 vs 3.7, P = .001), fewer patients requiring analgesics (30.8% vs 73.1%, P = .011), and an earlier resumption of oral intake (21.6 vs 26.0 hours, P = .002). The mean length of the scar in the LESS group was much smaller (2.3 vs 5.9 cm, P < .0001) with a statistically significant greater mean cosmetic satisfaction score (9.5 vs 9.1, P = .042). CONCLUSION The perioperative outcomes of transperitoneal LESS adrenalectomy for small adrenal tumors were comparable to those with the standard laparoscopic approach. It also provides better postoperative pain control, faster recovery of bowel function, and better cosmetic satisfaction than standard laparoscopy, albeit with a longer operative time.
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Affiliation(s)
- Linhui Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
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Sherif H, El-Tabey M, Abo-Taleb A, Abdelbaky A. Single-incision laparoscopic surgery in urology. Curr Urol 2012; 6:8-14. [PMID: 24917703 DOI: 10.1159/000338862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 02/21/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To assess the feasibility of single-incision laparoscopic surgery (SILS) in some urological surgeries. MATERIAL AND METHODS This prospective study was conducted on 40 patients (27 males and 13 females) from January 2010 to June 2011. Six procedures were done, SILS renal cyst decortication (n = 10), SILS varicocelectomy (n = 10), SILS orchiopexy (n = 10), SILS nephrectomy (n = 3), SILS pyelolithtomy (n = 6) and SILS adrenalectomy (n = 1). RESULTS Postoperative complications included ileus (10%) and fever (10%) in SILS renal cyst ablation. SILS varicocelectomy had postoperative sequalae as persistent varicocele (10%) and hydrocele (10%). SILS orchiopexy was also done with a success rate 100% in this series. SILS pyelolithotomy was successfully done in 5 out of 6 patients and only 1 patient was converted to conventional laparoscopy. In SILS nephrectomy 1 patient out of 3 was converted to conventional laparoscopy. CONCLUSION SILS in urology has proven to be safe and feasible in the hands of experienced laparoscopic surgeons, using specially designed ports and instruments in selected patients.
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Affiliation(s)
- Hammouda Sherif
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Magdy El-Tabey
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Abo-Taleb
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Abdelbaky
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
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Hsieh CH, Yang SSD, Chang SJ. Single-site surgery for simultaneous totally extraperitoneal bilateral herniorrhaphy and transperitoneal radical nephrectomy in one patient. Surg Innov 2012; 19:428-32. [PMID: 22431910 DOI: 10.1177/1553350612436567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM This study reports a case undergoing laparoendoscopic totally extraperitoneal herniorrhpahy and transperitoneal laparoscopic radical nephrectomy through transumbilical single-site incisions. METHOD A 56-year-old man presented with incidental left renal tumor and bilateral inguinal hernia. Accordingly, a homemade single-port in subumbilicus was applied for totally extraperitoneal herniorrhpahy, following which the incisional wound was extended upward for transperitoneal radical nephrectomy as well. RESULTS No extraumbilical port was required. Pathology confirmed the diagnosis of renal cell carcinoma. The peri- and postoperative course was quite smooth with rapid recovery, and the patient was discharged home on the fifth postoperative day. DISCUSSION The laparoendoscopic single-site surgery with homemade single-port allowed extraperitoneal and transperitoneal procedures to be carried out at the same time, which was feasible and safe with negligible complications. CONCLUSIONS Performing 2 procedures with single-site incision greatly diminished the number of port site incisions and offered obvious cosmetic advantage.
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Affiliation(s)
- Cheng-Hsing Hsieh
- Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan
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Transumbilical laparoendoscopic single-site pyeloplasty in infants and children: initial experience and short-term outcome. Pediatr Surg Int 2012; 28:321-5. [PMID: 22205576 DOI: 10.1007/s00383-011-3040-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2011] [Indexed: 10/25/2022]
Abstract
BACKGROUND Scar-free abdominal wall surgery is a research hotspot in recent years. This study presented surgical skills of transumbilical laparoendoscopic single-site pyeloplasty (LESS-P) for pediatric patients with ureteropelvic junction obstruction (UPJO) and its clinical application. METHODS Twenty-four pediatric patients with UPJO had transumbilical LESS-P performed by the same surgeon from June to December 2010. Among them, 16 were males and 8 females aged from 2 to 62 months with average of 14 months. Eighteen patients had obstruction on the left ureteropelvic junction and six on the right. The renal pelvis and ureter were anastomosed using 5-0 absorbable sutures and a double-J ureteric stent was placed through the anastomotic stoma. RESULTS All operations were successful. None was converted to open surgery and no additional sheath tube or incision besides umbilicus was needed. No intraoperative complications occurred. Ectopic blood vessels were found in two cases during surgery. The mean operative time was 145 min, and the average blood loss about 10 ml. Abdominal drainage tubes were remained for 2-9 days after surgery. The mean postoperative hospital time was 7 days. Two patients had postoperative urinary fistula, which naturally disappeared at 4 and 7 days of postoperation, respectively. Ultrasound and diuretic renal scintigraphy in follow-up found 23 patients had significantly decreased renal pelvis diameter. Although the other one showed no obvious change, but diuretic renography showed significantly improved excretion as indicated by increased glomerular filtration rate from 29 ml/min before surgery to 46 ml/min 6 months after surgery. CONCLUSION Pediatric transumbilical LESS-P is not only safe and effective but also can well meet patient's aesthetic desire for scar-free abdominal wall.
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Abstract
In the last decade, laparoendoscopic single-site surgery (LESS) has been touted to be the part of the 'evolution' of minimally invasive surgery. The hope is that reduced access points will ultimately decrease pain, morbidity, convalescence, and improve cosmesis. However, what is unique about LESS is that while laparoscopic literature sought to demonstrate superiority of the technique over that of open surgery, the publications on LESS generally seem to seek to demonstrate equivalence with laparoscopy, with the major focus being on cosmesis. Unfortunately, even in that regard the objective cosmesis data is lacking. Furthermore, patients rate cosmesis the least important of all factors. LESS has also been associated with increased risk of complication, increased surgical cost, and longer operative times. In the current review, an objective assessment of the literature will be used for comparison between current standard laparoscopic techniques and LESS with the hopes of answering the question: is LESS really more?
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Affiliation(s)
| | - Achim Lusch
- Department of Urology, University of California Irvine, Irvine, CA, USA
| | - Jaime Landman
- Department of Urology, University of California Irvine, Irvine, CA, USA
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Bin X, Bo Y, Dan S, Okhunov Z, Ghiraldi E, Huiqing W, Friedlander J, Liang X, Yinghao S, Kavoussi LR. A novel transvesical port for natural orifice translumenal endoscopic surgery. J Endourol 2011; 26:219-23. [PMID: 22191577 DOI: 10.1089/end.2011.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the feasibility of a novel transvesical port (TVEP) for natural orifice translumenal endoscopic surgery (NOTES) in the porcine model. MATERIALS AND METHODS The TVEP consisted of an internal guide core and external sheath design using computer-aided design software. Transvesical peritoneoscopy, renal biopsy, as well as combined transvesical/transgastric nephrectomy were performed through the TVEP in a porcine model. Operative parameters and port performance were measured. RESULTS Twelve procedures were successfully performed by four surgeons. No complications occurred with introduction of the TVEP. The mean time for placement was 5.6 minutes. Steady pressure controlled CO(2) pneumoperitoneum up to 15 mm Hg with a flow of 2 L/min was achievable. The average scoring by physician of the TVEP was 4.75 for ease of placement, 5 for ability to maintain pneumoperitoneum, 4.25 for convenience of inserting instruments, and 4.5 for overall satisfaction. The average score regarding instruments exchangeability, however, was relatively low: 3.25. CONCLUSIONS Real surgery using a novel TVEP is feasible in performing transvesical NOTES.
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Affiliation(s)
- Xu Bin
- Department of Urology, Changhai Hospital, Shanghai, China
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Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 2011; 98:1695-702. [PMID: 21964736 DOI: 10.1002/bjs.7689] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Conventional laparoscopy with three or more ports remains the 'gold standard' for cholecystectomy, but a laparoendoscopic single-site (LESS) approach is emerging, designed to decrease parietal trauma and improve cosmesis. This study compared conventional laparoscopic (CL) with LESS cholecystectomy, with short-term clinical results as the main outcomes. METHODS A randomized trial of CL and LESS cholecystectomies involving 150 patients was undertaken. Follow-up was for 1 month after surgery. The primary endpoint was body image results evaluated by means of validated scales. Secondary endpoints were: postoperative pain measured on a visual analogue scale, analgesia requirement, morbidity, quality of life (QoL) measured with Short Form 12, duration of operation, hospital stay, time to return to work and cost analysis. RESULTS Operating times and complications were similar in the two groups. Two LESS procedures (3 per cent) were converted to two-port laparoscopy owing to difficulties with exposure, and one CL operation was achieved through a single port because extensive fibrous peritoneal adhesions prevented placement of other ports. There were three and four port-site seroma/haematomas in the LESS and CL groups respectively. Better pain profiles and lower analgesia requirements were recorded in the LESS group (P < 0·001). QoL, body image and scar scale results were also better (P < 0·001). Operative costs were higher for LESS procedures (P < 0·001), although median time to return to work was shorter (P = 0·003). CONCLUSION LESS is an alternative to CL cholecystectomy associated with better cosmesis, body image, QoL and an improved postoperative pain profile.
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Affiliation(s)
- P Bucher
- Department of Surgery, University Hospital Geneva, Geneva, Switzerland.
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Symes A, Rane A. Urological applications of single-site laparoscopic surgery. J Minim Access Surg 2011; 7:90-5. [PMID: 21197251 PMCID: PMC3002016 DOI: 10.4103/0972-9941.72394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 08/27/2010] [Indexed: 01/31/2023] Open
Abstract
Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings.
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Affiliation(s)
- Andrew Symes
- Department of Urology, East Surrey Hospital, Redhill, U.K
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Ahmed I, Paraskeva P. A clinical review of single-incision laparoscopic surgery. Surgeon 2011; 9:341-51. [PMID: 22041648 DOI: 10.1016/j.surge.2011.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/25/2011] [Accepted: 06/12/2011] [Indexed: 12/20/2022]
Abstract
Laparoscopic surgery is one of the most significant surgical advances of the twentieth century. Recently, the focus has been on the development of minimally invasive techniques in the form of single-incision laparoscopic surgery. The single-incision technique provides a less invasive alternative to conventional laparoscopic surgery, requiring only one incision disguised within the umbilical folds in contrast to the three to five incisions in conventional laparoscopic surgery. The availability of a number of specialised ports has aided the development of single-incision laparoscopic surgery, and led to its widespread use. The successful use of single-incision laparoscopic surgery has been reported for a number of surgical procedures, and offers several potential benefits versus conventional laparoscopic surgery, including reduced pain, reduced time to recovery and improved cosmesis. This review of international literature assesses the current status, as well as the experience, of single-incision laparoscopic surgery within general, colorectal, bariatric, metabolic, gynaecological and urological surgery. The challenges faced with single-incision laparoscopic surgery are discussed, as well as the clinical studies that are required in order to establish single-incision surgery as a significant improvement to conventional laparoscopic surgery in terms of reduced pain and improved cosmesis.
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Affiliation(s)
- Irfan Ahmed
- Department of Surgery, Ward 31, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZA, UK.
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