Category: New Technology: Laparoscopy & Robotics
Introduction & Objective : To describe our experience in suprapubic-assisted laparoendoscopic single-site surgery(SA-LESS) in urology, and to evaluate its clinical value.
Methods : A retrospective analysis of 745 cases of SA-LESS surgerywas performed. There were 462 males and 283 females. The average age was 43.5 years. 68 cases of adrenal tumors, 137 cases of renal tumors, 182 cases of non-functional kidneys, 40 cases of renal cysts, 17 cases of duplex kidneys, 5 cases of renal tuberculosis, 54 cases of renal pelvis tumors, 187 cases of renal pelvis or ureteral calculi, 18 cases of UPJO, 34 cases of ureteral stenosis or atresia, 1 case of retroperitoneal mass and 2 cases of chyluria. One 5 and 10 mm trocars were inserted into the umbilical edge. A 10 mm trocar was inserted into abdominal cavity below the pubic hairline, through which a 10 mm 30° or 5 mm 0° laparoscope was placed. Some bigger specimens were removed after the incisions below the pubic hairline were enlarged.
The procedures of SA-LESS were successfully completed in 727 patients, except for 10 cases of open conversion, 8 cases of conversion to standard laparoscopic surgery. The procedures included adrenalectomy (N=67), nephrectomy (N=282; simple 169, radical 113), partial nephrectomy (N=22), renal cyst to the top surgery(N=40), heminephroureterctomy for duplex kidney (N=17) , tuberculosis and ureterectomy(N=5), nephroureterectomy (N=52), upper urinary tract incision lithotomy(N=187), renal pelvic angioplasty (N=18), ureteral stenosis resection and end anastomosis (N=6) , ureteral bladder replantation (N=28), retroperitoneal tumor resection (N=1) and renal pedicle lymphatic ligation (N= 2). The mean operative time was 75min, 90 min, 90min, 95min, 43min, 120min, 135min, 160min, 75 min, 138 min, 135min, 145min, 75min, and 85min, respectively. The estimated blood loss was 70ml, 160 ml, 250 ml, 130 ml, 30ml, 150 ml, 240 ml, 260 ml, 60ml, 200 ml, 100ml, 220 ml, 300ml, and 60ml. The mean VAS of 48 hours after operation was 2.1points. the average hospital stay was 6.5d. Major complications occurred in 27 cases. There were 665 cases followed up. The mean follow-up of 42 months showed that no infection in the abdominal or pelvic cavity or celiocele and no primary disease recurrence occurred.
SA-LESS is the innovation and optimization for LESS in urology, which is safe and feasible with the advantages of less pain and good cosmetic results. SA-LESS can be used as a transitional procedure for LESS, which is worth applying in clinical practice.
Guoxi Zhang– No.23 Qingnian Road, Ganzhou,China, First affiliated hospital of Gannan medical university, Ganzhou, Jiangxi, China (People's Republic)