CU 49. Retroperitoneal laparoendoscopic single - site radical nephrectomy using self - made single - port device: Initial experience

Objective: To present clinical experience with retroperitoneal laparoendoscopic single-site surgery(LESS) radical nephrectomy (RN) using self-made single-port device.

Methods: Between July 2010 and July 2011, a total of 12 patients underwent retroperitoneal LESS radical nephrectomy by one experienced surgeon, including 5 patients with RCC and 7 patients with upper urinary tract urothelial carcinoma who also underwent ureterectomy and excision of the bladder cuff. All procedures were carried within retroperitoneum through an incision 3 cm above the iliac crest, the length of which was 3 cm to 4 cm. After extending the retroperitoneum with a ballonet, a self-made single-port device was placed and surgery procedures were performed with flexible and standard laparoscopic instruments. All specimens were extracted intact through the extended incisions (about 6-8 cm) or a separated incision.

Results: Mean patient age was 70 (56-88), with 3 male patients and 9 female, and mean patient BMI was 22.4 kg/m². The mean estimated blood loss (EBL) was 83 mL (0-400 mL). and the mean operation time was 94 minutes (60-191 minutes). All procedures were completed successfully, with no conversion to standard multiport laparoscopic or open surgery and there were no intra-operation complications. Postoperative hospital stay was 7 (5-10) days. One patient (8.3%) was noted to have urinary tract infection post-operatively.

Conclusions: For proper selected patients, the retroperitoneal LESS radical nephrectomy is safe and feasible, but observation for long-term outcome as well as improvements of the instruments and surgery technique are needed.