Angulo J C, Redondo C, Gimbernat H, Ramón de Fata F, García-Tello A, García-Mediero J M
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
Actas Urol Esp. 2015 May;39(4):253-8. doi: 10.1016/j.acuro.2014.07.004. Epub 2014 Oct 23.
Umbilical laparoendoscopic single-site (LESS) surgery represents an excellent alternative to laparoscopic or robotic multiport surgery. LESS surgery offers faster recovery, less postoperative pain and optimal cosmetic results. LESS is possible in virtually any urologic surgery.
We present a 38-year-old male with BMI 31.2 and with history of stage I nonseminomatous mixed germ cell tumor showing interaortocaval lymph node recurrence without elevation of tumor markers. Patient was undergone to right laparoendoscopic single-site retroperitoneal lymph node dissection (LDRP-LESS) by umbilical approach using a single-site multichannel KeyPort (Richard Wolf GmbH, Knittlingen, Germany).
After the placement of the device and triangulation of the clips, we proceeded to operate on posterior parietal peritoneum. The descending colon was mobilized to access the retroperitoneum. Complete retroperitoneal lymph node dissection on the right side from iliac vessels to renal vessels, including the paracaval and interaortocaval space, was performed. The specimen was inserted into a laparoscopic bag and was removed together with multichannel system. Abdominal drainage was not employed. Surgical time was 85 min and estimated bleeding 50 cc. The patient was very satisfied with the cosmetic results and was discharged the following day without needing analgesia. The pathology report revealed metastatic seminoma in 5 of 11 lymph nodes receiving systemic chemotherapy (VP16-CDDPs) for 4 cycles with good tolerance. A year later, the patient was disease-free and had no complications.
Umbilical primary LDRP-LESS, with excellent oncologic and cosmetic results, is feasible in selected cases. This approach could be considered the least invasive surgical option economically advantageous due to the reusable nature of the instruments used.
脐部单孔腹腔镜手术（LESS）是腹腔镜或机器人多孔手术的绝佳替代方案。LESS手术恢复更快、术后疼痛更少且美容效果极佳。几乎任何泌尿外科手术都可以采用LESS手术。
我们报告一例38岁男性，体重指数（BMI）为31.2，有I期非精原性混合生殖细胞肿瘤病史，显示腹主动脉腔静脉间淋巴结复发，肿瘤标志物未升高。患者通过脐部入路，使用单孔多通道KeyPort（德国克尼廷根的理查德·沃尔夫有限公司）接受了右侧单孔腹腔镜腹膜后淋巴结清扫术（LDRP-LESS）。
放置设备并夹闭三角定位后，我们开始处理后腹膜壁层。游离降结肠以进入腹膜后间隙。从髂血管至肾血管进行了右侧完整的腹膜后淋巴结清扫，包括腔静脉旁和腹主动脉腔静脉间间隙。标本被放入一个腹腔镜袋中，与多通道系统一起取出。未放置腹腔引流。手术时间为85分钟，估计出血量为50毫升。患者对美容效果非常满意，术后第二天无需镇痛即可出院。病理报告显示，在接受4个周期全身化疗（VP16-顺铂）且耐受性良好的11个淋巴结中，有5个存在转移性精原细胞瘤。一年后，患者无疾病且无并发症。
脐部原发性LDRP-LESS在选定病例中可行，具有良好的肿瘤学和美容效果。由于所用器械可重复使用，这种方法可被认为是经济上有利的侵入性最小的手术选择。
