Laparoendoscopic single-site ureterolithotomy for upper ureteral stone disease: the first 30 cases in a multicenter study

The Safety and Feasibility of the Single-Port Laparoscopic Repair of Intraperitoneal Bladder Rupture

OBJECTIVE

To evaluate the efficacy and safety of laparoendoscopic single-site surgery (LESS) in the repair of intraperitoneal bladder rupture.

PATIENTS AND METHODS

All consecutive patients who underwent LESS for intraperitoneal bladder rupture in three hospitals in Korea were included prospectively in this study. LESS was performed using a homemade single-port device composed of an Alexis wound retractor and a surgical glove.

RESULTS

Of the 22 patients, 18 were male. The mean age was 40.50 ± 11.83 years. The mean body mass index was 24.19 ± 2.61 kg/m². The cause of rupture was trauma (n = 21) or iatrogenic injury (n = 1). The mean bladder rupture diameter was 3.41 ± 1.01 cm. LESS bladder rupture repair was completed effectively in all patients. The mean operative time was 89.05 ± 11.29 minutes. The mean length of hospital stay was 2.91 ± 0.53 days. Postoperatively, none of the patients required patient-controlled analgesia, and none developed major complications. The urethral Foley catheter was removed 7.68 ± 2.08 days after surgery.

CONCLUSIONS

LESS repair of intraperitoneal bladder rupture, which involves a homemade single-port device, was a feasible and safe alternative to conventional laparoscopy in this case series.

Percutaneous nephrolithotomy vs laparoscopic ureterolithotomy for large upper ureteral stone: A review article

To investigate the best treatment option for large upper ureteral stone, percutaneous nephrolithotomy or laparoscopic ureterolithotomy. We searched three key word of upper ureteral stone, laparoscopic ureterolithotomy, percutaneous nephrolithotomy in PubMed, Scopus and Ebsco. We found approximately twenty suitable articles about this subject since January 1980 until January 2014. All articles studies and reviewed meticulously and brief review of these articles was written and some Ideas of experts was added. In many studies, it is suggested that success rate and complications of laparoscopic ureterolithotomy and percutaneous nephrolithotomy are the same, but percutaneous nephrolithotomy has less hospital stay time, duration of surgery and it is more cost effective. Overall it seems that percutaneous nephrolithotomy for treatment of upper ureteral stones is preferable rather than laparoscopic ureterolitothomy

Our experience with retroperitoneal laparoendoscopic single-site ureterolithotomy

AIM

To report our experience with retroperitoneal laparoendoscopic single-site (LESS) ureterolithotomy for the management of large proximal ureteral stones.

PATIENTS AND METHODS

From July 2011 to April 2012, 20 patients underwent retroperitoneal LESS ureterolithotomy. The indications for the operation were impacted upper ureteral stones larger than 15 mm. A reusable elastic single-port device with 3 working channels was inserted through the 2.5-cm incision at the midpoint between the costal arch and iliac crest on the mid-axillary line. A rigid 10-mm 30° extra-long laparoscope was introduced for monitoring, and a combination of lengthened pre-bent and conventional laparoscopic instruments was used for handling. The surgical procedure was similar to conventional retroperitoneal laparoscopic ureterolithotomy.

RESULTS

Retroperitoneal LESS ureterolithotomy was completed in all of the patients. The mean stone size was 18.8 mm (range 16-28). The mean operative time was 108 min (range 75-140). Significant bleeding was not observed, and no major intraoperative complications occurred in any of the patients. The mean hospital stay was 4.4 days (range 3-7).

CONCLUSIONS

Retroperitoneal LESS ureterolithotomy, using a reusable elastic single-port device, is technically feasible and safe, and the combination of conventional and pre-bent laparoscopic instruments represents an attractive option for retroperitoneal LESS.

Retrograde, antegrade, and laparoscopic approaches to the management of large upper ureteral stones after shockwave lithotripsy failure: a four-year retrospective study

PURPOSE

We compare the success rate and complications of retrograde ureteroscopy, laparoscopic ureterolithotomy, and percutaneous nephrolithotomy for the management of large upper ureteral stones.

PATIENTS AND METHODS

We retrospectively analyzed data from 73 patients with large (≥1 cm) upper ureteral stones at two institutions from January 2010 to May 2013. Twenty-two patients underwent retrograde ureteroscopy (group ULS), 30 patients underwent percutaneous nephrolithotripsy (group PCNL), and 21 patients underwent laparoscopic ureterolithotomy (group LS) for removal of upper ureteral stones. CT, intravenous urography, and ultrasound were performed 1 week and 1 month after surgical removal.

RESULTS

There were no significant differences in age, sex, or stone size among the three groups. Mean estimated blood loss and mean hospital stay showed a statistically significant difference among the three groups. Success rates in the PCNL, LS, and ULS groups were 100%, 90.5%, and 77.3%, respectively. The procedures of two patients in group LS were converted to open surgery because of the inability to find the ureteral stone in one patient and an adhesion too difficult to dissect in the other. The procedures of two patients in the ULS group were converted to LS, and those of three patients were converted to PCNL because of severe edema impaction at the site of the stone, a sharply angulated ureter obstruction, upward migration of the stone (seven patients), and intraoperative complications (two patients).

CONCLUSIONS

Percutaneous antegrade nephrolithotomy is a safe and effective minimally invasive treatment for patients with large upper ureteral stones that has several advantages over retrograde ureteroscopy and laparoscopic ureterolithotomy. Thus, percutaneous antegrade nephrolithotomy is recommended as a safe and good treatment option for large upper ureteral stones. A combined procedure (e.g., ureteral push-back and percutaneous removal) can be considered in some patients.

Retroperitoneal laparoendoscopic single-site ureterolithotomy for upper ureteral stone disease

OBJECTIVE

The aim of this article was to present this group's clinical experience with retroperitoneal laparoendoscopic single-site (LESS) ureterolithotomy for the management of upper ureteral stones in selected patients.

MATERIAL AND METHODS

From May 2011 to November 2012, retroperitoneal LESS ureterolithotomy was performed in 22 patients at Xiangya Hospital. During the operation, a transverse skin incision was made approximately 2.5 cm in length along the lower margin of the 12th rib at the midaxillary line, and a single port was inserted. Standard steps of a multisite retroperitoneoscopic ureterolithotomy with a combination of conventional straight instruments and bent instruments were performed.

RESULTS

All cases were completed successfully without conversion to standard laparoscopy or open surgery. No additional ports or expensive flexible instruments were required. Overall, mean operative time was 98.5 min (range 76-174 min) and mean estimated blood loss was 33.4 ml (range 18-53 ml). Mean hospital stay after surgery was 3.7 days (range 3-5 days). One patient had fever postoperatively due to an Escherichia coli urinary tract infection, which resolved with appropriate antibiotic therapy. There were no major complications. The mean follow-up period was 10.5 months (range 3-21 months). All patients were asymptomatic and did not exhibit signs or symptoms of obstruction or stricture.

CONCLUSIONS

Retroperitoneal LESS ureterolithotomy is a feasible, safe and effective surgical method for the treatment of upper ureteral stones in select patients. Prospective studies based on more patients are needed to evaluate further its advantages over conventional laparoscopic ureterolithotomy.

Comparative study of outcome in treating upper ureteral impacted stones using minimally invasive percutaneous nephrolithotomy with aid of patented system or transurethral ureteroscopy

OBJECTIVE

To determine an efficient method for treating upper ureteral impacted stones, we compared the outcome of minimally invasive percutaneous nephrolithotomy with the aid of our patented system and transurethral ureteroscopy.

MATERIALS AND METHODS

A total of 182 patients with complicated impacted upper ureteral stones above the level of L4 were randomly divided into 2 groups. Group 1 included 91 patients who were treated with minimally invasive percutaneous nephrolithotomy with the aid of a patented system. Group 2 included 91 patients who were treated with ureteroscopy. The patients underwent postoperative shock wave lithotripsy, when necessary. The operative time, stone clearance rate, operative complication markers (amount of intraoperative bleeding and postoperative fever rate), and cost of treatment were compared.

RESULTS

A significantly shorter operative time, greater rate of stone clearance, lower need for postoperative shock wave lithotripsy, and lower rate of postoperative fever was found in group 1 than in group 2 (P <.05). However, the cost of treatment and amount of intraoperative bleeding were significantly greater.

CONCLUSION

We believe minimally invasive percutaneous nephrolithotomy with the aid of the patented system could be the first choice in treating complicated impacted upper ureteral stones above the level of L4.

[Current state of single-port transumbilical surgery in urology: challenges and applications]

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.

A novel case of laparoscopic ureterolithotomy in a partial duplex ureteric collecting system: can open procedures still be justified in the minimally invasive era?

BACKGROUND

Impacted ureteric stones can pose a treatment challenge due to the high level of failure of ESWL and endourological approaches. Laparoscopic ureterolithotomy can provide a safe and successful alternative to these and open, invasive procedures.

METHODS

Interval laparoscopic ureterolithtomy was carried out following placement of a percutaneous nephrostomy. This was performed through an trans-peritoneal approach with the ureterotomy closed by intracorporeal suturing and placement of a JJ stent without the need for an abdominal wound drain.

CONCLUSION

Laparoscopic ureterolithotomy is a safe, minimally invasive method of managing large, impacted ureteric stones with minimal associated patient morbidity.

Is it necessary to place a Double J catheter after laparoscopic ureterolithotomy? A four-year experience

PURPOSE

To assess the necessity of placing a ureteral stent after transperitoneal laparoscopic ureterolithotomy (TPLU).

PATIENTS AND METHODS

In the period from May 2006 to November 2010, 46 patients underwent TPLU. There were 13 females and 33 males. All patients had an impacted stone larger than 1.5 cm in the upper and middle parts of the ureter. TPLU was performed as either a primary therapy or as a salvage therapy in patients in whom another treatment had failed. The exclusion criteria were pregnancy, a body mass index more than 35, and patients with abnormal results on coagulative tests. In all cases, after removing the stone, the ureter was sutured. In the first 23 patients, no ureteral catheter was placed, but in the second 23 patients, a Double J catheter was inserted through the ureter.

RESULTS

In one case, the stone was pushed back. The stone-free rate was 97.8%. There were four cases of prolonged urinary leakage after the surgery. All of them were in the group in whose members the Double J catheter had not been placed. The problem was resolved in one patient spontaneously after 4 days, but for the other three patients, a Double J catheter was placed and the leakage was stopped in 24 hours. There was no case of urinary leakage in the second group of patients with a placed Double J catheter.

CONCLUSION

Placing a Double J catheter during surgery does not increase the time of operation and may play a role in prevention of urinary extravasation after laparoscopic ureterolithotomy.

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

Purpose

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

Materials and Methods

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

Results

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

Conclusions

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

Concomitant laparoendoscopic single-site surgery for vesicolithotomy and finger-assisted single-port transvesical enucleation of the prostate

Transurethral resection of the prostate is the most common surgery for benign prostatic hyperplasia. However, it doesn't work best for men with very large prostate and bladder stones. Herein we report our initial experience with concomitant laparoendoscopic single-site surgery and finger-assisted single-port transvesical enucleation of the prostate for the treatment of the condition.

Single-port transvesical enucleation of the prostate for benign prostatic hyperplasia with severe intravesical prostatic protrusion

OBJECTIVES

To introduce the surgical techniques of a single-port transvesical enucleation of the prostate (STEP) for enlarged prostates with severe intravesical prostatic protrusion (IPP) presenting with lower urinary tract symptoms (LUTS).

PATIENTS AND METHODS

Our study included 7 patients with prostates larger than 80 mL and with severe IPP who underwent STEP. All the procedures were performed using a home-made single-port device through a 3-cm midline incision at the level three fingerbreadths above the symphysis pubis. Rigid laparoscopic instruments and Harmonic Scalpels(®) were used to enucleate the large adenoma of the prostate.

RESULTS

All the procedures were completed satisfactorily, with no intra and early postoperative complications. The mean resected prostatic weight was 54.14 ± 8.38 g, and the mean operative time was 191.86 ± 40.88 min. The mean time for catheterization was 5.29 ± 1.80 days. The postoperative 3-month international prostate symptoms score (IPSS) and maximal flow rate (Qmax) were improved following STEP (IPSS; 23.57 ± 2.15 vs. 11.43 ± 2.44, Qmax; 17.14 ± 3.44 mL/s vs. 6.71 ± 2.29 mL/s).

CONCLUSIONS

Laparoendoscopic single-site surgery (LESS) and enucleation of the prostate with rigid laparoscopic instruments might be difficult but is feasible. STEP may be a new treatment option for use in open prostatectomies for enlarged prostates with severe IPP in carefully selected patients.