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768 UROLOGIC LAPAROENDOSCOPIC SINGLE SITE SURGERIES USING HOMEMADE SINGLE PORT DEVICE: A SINGLE CENTER EXPERIENCE OF 200 CONSECUTIVE CASES
Vol. 185, No. 4S, Supplement, Monday, May 16, 2011
THE JOURNAL OF UROLOGY姞
e309
CONCLUSIONS: LESS is technically feasible and safe for various urologic diseases. However, surgical experience and long-term follow-up are needed to test the superiority of LESS.
Source of Funding: Novadaq, Bonita Springs, FL, USA Source of Funding: None
768 UROLOGIC LAPAROENDOSCOPIC SINGLE SITE SURGERIES USING HOMEMADE SINGLE PORT DEVICE : A SINGLE CENTER EXPERIENCE OF 200 CONSECUTIVE CASES Kyung Hwa Choi*, Won Sik Ham, Koon Ho Rha, Jae Won Lee, Seoul, Korea, Republic of; Hwang Gyun Jeon, Seongnam, Korea, Republic of; Francis Raymond P Arkoncel, Seung Choul Yang, Woong Kyu Han, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: With advancements in laparoscopic instruments, consideration of cosmesis and trends for minimal invasiveness, the number of laparoendoscopic single site surgery (LESS) has been performed for diverse urologic diseases. We report our experience with 200 patients who underwent LESS surgery using a homemade single port device in a single institution. METHODS: Between December 2008 to October 2010, 200 consecutive LESS urologic operations were done in Shinchon Severance hospital. Conventional LESS (C-LESS) and robotic LESS (RLESS; da Vinci S, Intuitive Surgical, USA) procedures were performed by three expert laparoscopic surgeons. All procedures were done using a homemade single port device with size 7 non-powdered surgical gloves and the Alexis¢ç wound retractor which was inserted through a 2 to 4cm umbilical incision. The port device was made by placing gloves to the retractor outer ring by suturing and repeated folding to prevent air leak. A homemade single port was established by inserting three or four 12-mm and 8-mm trocars through the fingers of a surgical gloves and securing it to the port with rubber band. In R-LESS, an additional trocar was inserted in the midline below the subxiphoid process or alongside the homemade single port to establish a 12-mm hybrid port if needed. RESULTS: Of the 200 patients, 111 underwent C-LESS and 89 underwent R-LESS. Mean patient age was 53 years, mean operative time was 190.9 minutes, and mean estimated blood loss was 204 mL. Intraoperative complications occurred in seven cases (3.5%), and postoperative complications in nine cases (4.5%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification). Conversion to mini-incision open surgery occurred in eight (4%) cases. Regarding oncologic outcomes, there were five cases of distant metastasis in total 101 cases of cancer operation including aggressive progression of Ewing sarcoma and leiomyosarcoma. Two bladder recurrence was occurred in nephroureterectomy cases. Operative records, pathologic results and complication data are described in Table 1.
769 EFFICACY OF LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR TUMORS LARGER THAN 4 CM Francesco Porpiglia*, Cristian Fiori, Andrea Di Stasio, Nicoletta Serra, Orbassano - Torino, Italy; Riccardo Bertolo, Fabrizio Mele, Ivano Morra, Orbassano (Turin), Italy; Roberto Mario Scarpa, Orbassano - Torino, Italy INTRODUCTION AND OBJECTIVES: In recent years, laparoscopic partial nephrectomy (LPN) has been used widely for the treatment of small renal masses (SRMs) and in some centres, it has become the standard treatment as it duplicates the principles of open partial nephrectomy (OPN) with the advantages of minimal invasiveness. While the role of LPN for SRMs is well documented, there are few reports regarding the use of LPN for large masses (more than 4 cm). The aim of our study was to investigate the perioperative safety of LPN for large renal masses. METHODS: After IRB approval, the data from 100 consecutive patients that underwent LPN with transperitoneal or retroperitoneal approach at our Institution from January 2005 to June 2009 were extracted from our prospectively maintained database. We started our experience with LPN in May 2000, but we excluded the first cases from our analysis and considered the entire data series from the first patient treated for a tumour ⬎4 cm. Patients were consecutive and during the study period no OPN were performed at our Institution. The patients were divided into two groups according to radiological tumour size: group A (67 pts) with tumours ⬍ 4 cm and group B (33 pts) with tumours ⬎4 cm. Demographic, perioperative and pathological data were evaluated. Groups were compared by using Student t test. RESULTS: The two groups were comparable in terms of demographic data. Mean tumour size was 2.4 and 5 (p⫽0.0001) cm for group A and B, respectively. Group B tumours were more complex, as reflected by significant increases in central location (p⫽0.002), and significant increases for transperitoneal approach, pelvicalyceal repair and warm ischemia time (WIT) (19’ vs. 28’). Complications were recorded in 9 group A patients (13.4%) and 9 group B patients (27.2%) (p ⫽0.09). There was no difference between preoperative and postoperative serum creatinine levels in either group, while a significant difference was found in postoperative estimated glomerular filtration rate (eGFR) between groups (p⫽0.004). The incidence of carcinoma
THE JOURNAL OF UROLOGY姞
e309
CONCLUSIONS: LESS is technically feasible and safe for various urologic diseases. However, surgical experience and long-term follow-up are needed to test the superiority of LESS.
Source of Funding: Novadaq, Bonita Springs, FL, USA Source of Funding: None
768 UROLOGIC LAPAROENDOSCOPIC SINGLE SITE SURGERIES USING HOMEMADE SINGLE PORT DEVICE : A SINGLE CENTER EXPERIENCE OF 200 CONSECUTIVE CASES Kyung Hwa Choi*, Won Sik Ham, Koon Ho Rha, Jae Won Lee, Seoul, Korea, Republic of; Hwang Gyun Jeon, Seongnam, Korea, Republic of; Francis Raymond P Arkoncel, Seung Choul Yang, Woong Kyu Han, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: With advancements in laparoscopic instruments, consideration of cosmesis and trends for minimal invasiveness, the number of laparoendoscopic single site surgery (LESS) has been performed for diverse urologic diseases. We report our experience with 200 patients who underwent LESS surgery using a homemade single port device in a single institution. METHODS: Between December 2008 to October 2010, 200 consecutive LESS urologic operations were done in Shinchon Severance hospital. Conventional LESS (C-LESS) and robotic LESS (RLESS; da Vinci S, Intuitive Surgical, USA) procedures were performed by three expert laparoscopic surgeons. All procedures were done using a homemade single port device with size 7 non-powdered surgical gloves and the Alexis¢ç wound retractor which was inserted through a 2 to 4cm umbilical incision. The port device was made by placing gloves to the retractor outer ring by suturing and repeated folding to prevent air leak. A homemade single port was established by inserting three or four 12-mm and 8-mm trocars through the fingers of a surgical gloves and securing it to the port with rubber band. In R-LESS, an additional trocar was inserted in the midline below the subxiphoid process or alongside the homemade single port to establish a 12-mm hybrid port if needed. RESULTS: Of the 200 patients, 111 underwent C-LESS and 89 underwent R-LESS. Mean patient age was 53 years, mean operative time was 190.9 minutes, and mean estimated blood loss was 204 mL. Intraoperative complications occurred in seven cases (3.5%), and postoperative complications in nine cases (4.5%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification). Conversion to mini-incision open surgery occurred in eight (4%) cases. Regarding oncologic outcomes, there were five cases of distant metastasis in total 101 cases of cancer operation including aggressive progression of Ewing sarcoma and leiomyosarcoma. Two bladder recurrence was occurred in nephroureterectomy cases. Operative records, pathologic results and complication data are described in Table 1.
769 EFFICACY OF LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR TUMORS LARGER THAN 4 CM Francesco Porpiglia*, Cristian Fiori, Andrea Di Stasio, Nicoletta Serra, Orbassano - Torino, Italy; Riccardo Bertolo, Fabrizio Mele, Ivano Morra, Orbassano (Turin), Italy; Roberto Mario Scarpa, Orbassano - Torino, Italy INTRODUCTION AND OBJECTIVES: In recent years, laparoscopic partial nephrectomy (LPN) has been used widely for the treatment of small renal masses (SRMs) and in some centres, it has become the standard treatment as it duplicates the principles of open partial nephrectomy (OPN) with the advantages of minimal invasiveness. While the role of LPN for SRMs is well documented, there are few reports regarding the use of LPN for large masses (more than 4 cm). The aim of our study was to investigate the perioperative safety of LPN for large renal masses. METHODS: After IRB approval, the data from 100 consecutive patients that underwent LPN with transperitoneal or retroperitoneal approach at our Institution from January 2005 to June 2009 were extracted from our prospectively maintained database. We started our experience with LPN in May 2000, but we excluded the first cases from our analysis and considered the entire data series from the first patient treated for a tumour ⬎4 cm. Patients were consecutive and during the study period no OPN were performed at our Institution. The patients were divided into two groups according to radiological tumour size: group A (67 pts) with tumours ⬍ 4 cm and group B (33 pts) with tumours ⬎4 cm. Demographic, perioperative and pathological data were evaluated. Groups were compared by using Student t test. RESULTS: The two groups were comparable in terms of demographic data. Mean tumour size was 2.4 and 5 (p⫽0.0001) cm for group A and B, respectively. Group B tumours were more complex, as reflected by significant increases in central location (p⫽0.002), and significant increases for transperitoneal approach, pelvicalyceal repair and warm ischemia time (WIT) (19’ vs. 28’). Complications were recorded in 9 group A patients (13.4%) and 9 group B patients (27.2%) (p ⫽0.09). There was no difference between preoperative and postoperative serum creatinine levels in either group, while a significant difference was found in postoperative estimated glomerular filtration rate (eGFR) between groups (p⫽0.004). The incidence of carcinoma