Department of Urology, Institute of Nephro-Urology , Bangalore, Karnataka, India .
J Endourol. 2013 Nov;27(11):1354-60. doi: 10.1089/end.2013.0311. Epub 2013 Sep 17.
To present our initial experience with laparoendoscopic single-site (LESS) urologic surgery using conventional laparoscopic instruments and to assess its feasibility and safety.
In 20 patients, we performed LESS urologic surgery, which included simple nephrectomy in 9, nephroureterectomy in 1 for a refluxing nonfunctioning kidney, radical nephroureterectomy in 1, heminephroureterectomy in 1 for a nonfunctioning upper moiety in a complete duplex kidney, marsupialization of a renal cyst in 1, ureterolithotomy in 1, varicocelectomy in 2, pyeloplasty in 2, vesicovaginal fistula (VVF) repair in 1, and orchiopexy in 1. LESS was performed using a small periumbilical incision, inserting regular trocars, and using a conventional 30-degree laparoscope and laparoscopic instruments. Data were collected prospectively with respect to feasibility, intraoperative or postoperative complications, postoperative pain, analgesic requirement, and recovery.
Since March, 2012, a total of 20 patients have undergone LESS for various urologic conditions. All cases were completed successfully, without conversion to a standard laparoscopic or open approach. The total operative time for the nephrectomy, nephroureterectomy, pyeloplasty, VVF repair, ureterolithomy, varicocelectomy, or orchiopexy was 134 ± 20.06, 186 ± 40, 135 ± 21, 180, 150, 55, and 60, minutes, respectively. The mean blood loss was 100 mL. No intraoperative complication occurred. The mean pain score on the visual analog scale was 8.35 ± 0.9 (8-10) on day 1, 4.8 ± 1.6 (2-8) on day 2, and 2 ± 1.2 (2-4) on day 3. Similarly, the mean analgesic requirement was 220 ± 41 mg, 85 ± 74 mg, and 30 ± 47 mg of intravenous tramadol, respectively. One patient had surgical emphysema of the abdomen and another had ileus for 4 days. The mean hospital stay was 2.9 ± 1.7 (2-7) days.
In selected patients, LESS for urological indications using conventional laparoscopic instruments is safe and feasible with no added cost. Additional experience and continued investigation are warranted.
介绍我们使用传统腹腔镜器械进行经脐单孔腹腔镜（LESS）泌尿外科手术的初步经验，并评估其可行性和安全性。
在 20 例患者中，我们进行了 LESS 泌尿外科手术，其中包括 9 例单纯性肾切除术、1 例反流性无功能肾的肾盂输尿管切除术、1 例根治性肾盂输尿管切除术、1 例完全重复肾的上半部分无功能行半肾切除术、1 例肾囊肿去顶术、1 例输尿管切开取石术、2 例精索静脉曲张切除术、2 例肾盂成形术、1 例膀胱阴道瘘（VVF）修补术和 1 例睾丸固定术。经脐小切口行 LESS，插入常规套管针，使用传统的 30°腹腔镜和腹腔镜器械。前瞻性收集可行性、术中或术后并发症、术后疼痛、镇痛需求和恢复情况的数据。
自 2012 年 3 月以来，共有 20 例患者因各种泌尿外科疾病接受了 LESS。所有病例均成功完成，无转为标准腹腔镜或开放手术。肾切除术、肾盂输尿管切除术、肾盂成形术、VVF 修补术、输尿管切开取石术、精索静脉曲张切除术和睾丸固定术的总手术时间分别为 134±20.06、186±40、135±21、180、150、55 和 60 分钟。平均失血量为 100 毫升。术中无并发症发生。术后第 1 天、第 2 天和第 3 天的视觉模拟评分平均疼痛评分分别为 8.35±0.9（8-10）、4.8±1.6（2-8）和 2±1.2（2-4）。同样，静脉注射曲马多的平均镇痛需求分别为 220±41mg、85±74mg 和 30±47mg。1 例患者出现腹部气肿，1 例患者出现肠梗阻 4 天。平均住院时间为 2.9±1.7（2-7）天。
在选择的患者中，使用传统腹腔镜器械进行 LESS 泌尿外科手术是安全可行的，且没有增加额外费用。需要更多的经验和持续的研究。
