单孔腹腔镜下根治性膀胱切除术10例报告

目的 探讨单孔腹腔镜根治性膀胱切除术的可行性及初步经验.方法 采用单孔腹腔镜技术完成根治性膀胱切除术10例.男9例,女1例.取下腹正中3～4 cm切口,置入QuadPort(2例)或自制开口器(2环1套法,8例)建立单孔腹腔镜手术通道,术中采用常规和预弯腹腔镜器械.手术步骤包括双侧标准盆腔淋巴结清扫、根治性膀胱切除及开放构建全去带乙状结肠原位新膀胱.结果 10例手术顺利.无中转开放手术或传统腹腔镜手术,未增加其他通道.单孔部分手术时间130～330 min,平均243 min.术中失血50～600 ml,平均270 ml,5例需输浓缩红细胞2～4 U.盆腔淋巴结、尿道及输尿管切缘均阴性.病理报告均为尿路上皮癌T1N0M0 2例,T2aN0M0 6例,T3aN0M0 2例.无围手术期死亡及严重并发症的发生.8例完成6个月以上的随访,白天排尿均完全可控,4例有夜间遗尿,未见肿瘤复发和远处转移.结论 单孔腹腔镜膀胱癌根治性切除术安全可行,美容效果较好,短期随访肿瘤控制效果好.自制开口器制作简单,操作方便,气密性好,成本低,能够完成单孔腹腔镜手术.

Abstract：

Objective To present our initial experience of pure laparoendoscopic single-site surgery (LESS) for radical cystectomy and bilateral pelvic lymph node dissections. Methods 10 patients with pathology confined bladder urothelial carcinoma underwent laparoendoscopic single-site radical cystectomy, including 9 males and 1 female. After a 3-4 cm lower median abdominal incision was made, quadport or homemade single multichannel port was inserted, and conventional and prebent laparoscopic instruments were utilized. The surgical procedure included bilateral pelvic lymphadenectomies, radical cystectomy and building with a sigmoid orthotopic neobladder by open surgery.Results No extra port needed, neither conversion to open or conventional laparoscopic surgery. The time of LESS procedure ranged from 130 to 330 min (mean 243 nin). Estimated blood loss ranged from 50 to 600 ml (mean 270 ml). 5 patients needed blood transfusion of 2 to 4 units. The pathologic evaluation revealed bladder urothelial carcinoma, negative margins and negative pelvic lymph node involvement. No mortality or severe complications were observed perioperatively. After followup of more than 6 months, all revealed controllable urination at daytime, while 4 revealed nocturnal incontinence and needed one or two pads during nighttime. No evidence of recurrent or metastatic disease was detected. Conclusions LESS radical cystectomy and bilateral lymphadenectomies was safe and feasible, and short-term follow-up showed good tumor control outcomes. Homemade single multichannel port made of two elastic ring and glove was simple and effective.     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

目的 评价改良的经腹腔途径腹腔镜下前列腺癌根治术的手术技术及其临床效果.方法 回顾性分析2008年1月至2010年6月行经腹腔途径腹腔镜下前列腺癌根治术的105例患者资料.患者年龄51～73岁,术前血清特异前列腺抗原平均13.6μg/L,前列腺体积平均45 ml,术前均由病理检查确诊,Gleason评分6～8分,核素骨扫描示无骨转移.经腹腔途径腹腔镜下前列腺癌根治术中对膀胱颈精囊腺分离以及膀胱颈后尿道吻合等技术进行了改良.结果 手术时间65～150 min,半均93 min.术中出血50～400 ml,平均115 ml,术中均未中转开放手术,无大血管及直肠损伤.术后切缘阳性24例,术后吻合口尿漏1例,无肠道并发症.术后平均7 d拔除尿管,拔管后正常尿控64例,术后3个月内恢复尿控33例,术后3～12个月内恢复尿控5例.术后随访5～33个月,平均16个月.随访期间有3例尿失禁,保留性神经患者中15例术后勃起功能良好,17例出现生化复发.结论 经腹腔途径腹腔镜下前列腺痛根治术手术操作空间大,解剖标志清晰,肿瘤治疗效果满意.对膀胱颈分离及后尿道吻合等技术的改进可明显缩短手术时间,提高手术效率,减少手术并发症.

Abstract：

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

经腹膜外途径机器人辅助腹腔镜根治性前列腺切除术的临床疗效

目的 比较经腹膜外途径机器人辅助腹腔镜根治性前列腺切除术（extraperitoneal robot-assisted laparoscopic radical prostatectomy,Ep-RARP）和经腹膜外途径腹腔镜根治性前列腺切除术（extraperitoneal laparoscopic radical prostatectomy,Ep-LRP）的临床疗效。方法 回顾性分析山东省立医院泌尿外科单人2016年1月至2022年12月诊断为前列腺癌且行经腹膜外途径根治性前列腺切除术（extraperitoneal radical prostatectomy,Ep-RP）的208例患者的临床资料,其中行Ep-RARP的120例作为观察组,行Ep-LRP的88例作为对照组。对两组患者的术前资料、手术时间、术中出血量、术中输血率、手术并发症、术后胃肠功能恢复时间、术后引流管留置天数、术后住院时间及术后病理切缘阳性率等进行比较。结果 Ep-RARP组比Ep-LRP在术中出血量[（141.8±78.2） vs.（178.0±131.1） ml]、术中输血率（1.7%vs.8.0%）、术后...     

经脐单孔多通道腹腔镜下肾切除术20例报告

目的 总结经脐单孔多通道腹腔镜下肾切除术的临床经验并评估其安全性和有效性.方法 2008年12月至2010年8月对20例患者行经脐单孔多通道腹腔镜下肾切除术.其中肾癌根治术9例(左肾8例,右肾1例;均为T1期),右输尿管癌肾切除1例,无功能肾切除10例(左侧5例,右侧5例).取脐旁2 cm切口进入腹腔,置入单孔多通道套件,5 mm一体化腹腔镜下,以普通腹腔镜器械及可弯器械相配合,完成肾切除术.根治性肾切除标本取出时需适当扩大脐部切口至6 cm.结果 20例中,1例右输尿管癌肾切除和1例右侧无功能肾切除因出血致视野不清,中转开放手术;18例手术顺利完成(2例肾癌根治术增加5 mm辅助通道),平均手术时间为197(85～510)min,平均出血量为126(50～400)ml,术中术后均未输血,术后平均住院时间6(3～14)d,术后平均留置引流管4(0～14)d.结论 经脐单孔多通道腹腔镜下肾切除术安全有效,且瘢痕较小,无功能肾切除术后几乎无瘢痕,美容效果佳.其临床治疗效果尚需大样本中远期随访和对照研究进一步证实.

Abstract：

Objective To summarize the clincical experience of transumbilical Laparoendoscopic Single-site (LESS) nephrectomy and to evaluate its safety and efficacy. Methods From December 2008 to August 2010, we have performed 20 cases of transumbilical LESS nephrectomy by Tri-Port system, of which 9 patients underwent LESS radical nephrectomy (left 8, right 1, stage T1 ), 1 patient underwent LESS radical resection of right ureteral carcinoma, 10 patients underwent LESS simple nephrectomy (left 5, right 5). The Tri-Port system was inserted transperitoneally through a 2 cm umbilical incision. A 5-mm 30° telescope was introduced through the port to visualize the operative field. Flexible equipment and standard laparoscopic equipment were used to perform the procedures.The incisions were extended to about 6cm in order to remove the specimens. Results Conversion to open surgery was necessary in one LESS radical resection of right ureteral carcinoma and one LESS simple nephrectomy, while the remaining 18 cases were successful (the addition of a single 5-mm port was necessary in 2 cases of LESS radical nephrectomy). The mean operative time was 197 min (85-510 min), mean estimated blood loss was 126 ml (50-400 ml), without blood transfusion in the perioperative period, mean postoperative hospital stay was 6.3 d (3-14 d), and mean duration of catheter drainage was 3.6 d (0- 14 d). Conclusions Transumbilical LESS nephrectomy is feasible, safe,minimally invasive and cosmetic. Long-term follow-up and a clinical control study are needed for evaluating clinical outcomes.     

单孔腹腔镜下根治性前列腺切除术的初步经验

目的 探讨单孔腹腔镜下根治性前列腺切除术(LESS-LRP)治疗早期前列腺癌的临床安全性及可行性.方法经腹膜外途径,应用单孔4通道技术,行LESS-LRP治疗早期前列腺癌2例.应用标准腹腔镜器械和5 mm头部可弯腹腔镜.记录患者手术前后PSA、手术时间、估计术中出血量、术中并发症、留置引流管时间、术后疼痛指数(VAPS)、术后住院时间、病理检查等资料,结合文献复习总结手术特点.结果 2例LESS-LRP手术均顺利完成,无中转标准腹腔镜或开放手术.2例手术时间分别为280、285 min,估计术中出血量分别为400、200 ml.术中无严重并发症.术后留置引流时间分别为2、6 d,术后第1天VAPS分别为1、0分,术后住院时间分别为14、7 d.无继发性出血和切口感染.标本外科切缘均阴性,2例病理分期均为pT2c N0M0.患者术后1个月1例PSA为0.033 ng/ml,1例尚未复查.结论 LESS-LRP治疗早期前列腺癌值得进一步临床探索性应用.

Abstract：

Objective To verify the safety and feasibility of applying laparoendoscopic singlesite radical prostatectomy (LESS-LRP) in the treatment of prostate cancer. Methods From Sept. to Dec. 2010, LESS-LRP was used to treat 2 early stage prostate cancer patients. The LESS-LRP was preformed through extra-peritoneal approach by using standard laparoscopic instruments and a 5 mm flexible laparoscope. This technique were evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative pain score (VAPS), post-operative hospital stay, pathological results and post-operative PSA levels. Results All procedures of the 2cases were completed with LESS-LRP without conversion to standard laparoscopic or open radical prostatectomy. The operative times for LESS-LRP were 280 and 285 min, estimated blood loss were 400 and 200 ml, respectively. There was no severe intraoperative complication. The drainage times were 2 and 6 d, the VAPS in the first post-operative day were 1 and 0, and post-operative hospital stay were 14 and 7 d. There was no secondary bleeding or wound infection. The 2 prostate cancer cases were all in pathological stage pT2c N0 M0. Surgical margins of the specimens were negative. The first case showed PSA of 0. 033 ng/ml 1 month after the surgery. Conclusion LESS-LRP can be an exploratory option in clinical for the treatment of prostate cancer.     

经脐单孔腹腔镜胆囊切除术的手术经验

目的 研究经脐单孔腹腔镜胆囊切除术临床可行性及安全性.方法 总结2009年2月至2010年12月、82例胆囊疾病患者实施经脐单孔腹腔镜胆囊切除术的经验,并分析手术中碰到的一些疑难问题和应对策略.结果 82例患者中,9例患者由于胆囊周围炎症、胆囊三角解剖困难及胆囊动脉结构变异等原因改行其他术式,其中6例改行二孔法腹腔镜胆囊切除术,3例中转常规开放性手术;其余73例手术均顺利完成单孔手术,成功率89.0%.手术时间平均48.4 min,手术出血平均20.8 ml.术后次日恢复流质饮食,住院3～6 d.术后平均随访13.7个月,均无胆管损伤、大出血、切口感染、胆漏、脐疝等并发症发生,术后复查切口愈合良好,瘢痕极隐蔽而不易察觉.结论 经脐单孔腹腔镜胆囊切除是安全可行的,技术上的难点容易突破.

Abstract：

Objective To study the feasibility and safety of transumbilical single incision laparoscopic cholecystectomy. Methods Eighty-two cases with gallbladder diseases were underwent with transumbilical single incision laparoscopic cholecystectomy. Some difficulties and countermeasure in operations were analyzed. Results Nine in all patients were converted because of the surrounding inflammation of gallbladder, difficult to dissect in Calot's triangulation and variation of gallbladder artery. Of them, 6 cases converted to two-hole laparoscopic cholecystectomy and 3 cases to open operation. Other 73 cases were successfully operated with transumbilical single incision laparoscopic cholecystectomy. The success rate was 89. 0%. The average operative duration was 48.4 min. The average operative blood loss was 20. 8 ml. Patients returned to liquid food on the first day after operation. Hospital duration was 3～6 d. During 13.7 months of follow-up, there was no bile duct injury, large bleeding, incision infection, bile fistula and umbilical hernia. The incision healed well. The scar in umbilicus was concealing and difficult to be observed. Conclusions Transumbilical single incision laparoscopic cholecystectomy is safe and feasible. The difficulties in technique are easy to be broken through.     

Hybrid natural orifice transluminal endoscopic surgery for ileocecal resection

Although laparoscopic colectomy is commonly performed around the world,an operative wound formed during the surgery is large but not sufficient enough to convert for the majority of open surgery.Thus,a certain sized skin incision is required to remove the resected colon.Here we report the case of a pure laparoscopic ileocecal resection which involves transanal specimen extraction.We present a case characterized by a laterally spreading type of tumor of the cecum.We performed a pure laparoscopic ileocecal resection and the resected specimen was removed transanally using colonoscopy.Intracorporeal functional anastomosis was then performed using a flexible linear stapling device under supporting barbed suture traction.The patient was discharged without complications on postoperative day 4.Laparoscopic colectomy performed with minimal incision could essentially increase the usage of this surgical technique.Although our method is restricted to flat or small lesions,we think it is a feasible and realistic solution for minimization of operative invasion because it involves specimen extraction through a natural orifice.     

单孔腹腔镜前列腺癌根治术：附5例报告

目的报道经脐部单孔多通道腹腔镜前列腺癌根治术手术的初步经验。方法 2010年6月至2010年11月,对5例TNM分期为T1b～T2的前列腺癌患者行经腹途径单孔腹腔镜前列腺癌根治术,所有患者既往无盆腔手术史。经脐部切口,长约4cm,置入单孔多通道设备（Quadport）,在此切口之外无附加任何其他操作通道。结果 5例手术均获得成功,无一例中转开放或传统腹腔镜手术。手术时间185～370min,平均303min。术中出血量220～650ml,平均431ml,无一例患者需输血。术后留置尿管时间12～21d,平均17d。无直肠损伤等并发症。术后住院时间12～25d,平均19d。所有病例术后病理均报告前列腺包膜完整,肿瘤切缘均为阴性。所有5例患者术后随访2～15周,控尿恢复良好,每天使用尿片约0～2片。结论单孔腹腔镜前列腺癌根治术是安全有效的治疗方法。     

Robotic single-port transumbilical surgery in humans: initial report

OBJECTIVE

To describe our initial clinical experience of robotic single‐port (RSP) surgery.

PATIENTS AND METHODS

The da Vinci® S robot (Intuitive, Sunnyvale, CA, USA) was used to perform radical prostatectomy (RP), dismembered pyeloplasty, and radical nephrectomy. A robot 12‐mm scope and 5‐mm robotic grasper were introduced through a multichannel single port (R‐port, Advanced Surgical Concepts, Dublin, Ireland). An additional 5‐mm or 8‐mm robotic port was introduced through the same umbilical incision (2 cm) alongside the multichannel port and used to introduce robotic instruments. Vesico‐urethral anastomosis and pelvi‐ureteric anastomosis were successfully performed robotically using running intracorporeal suturing.

RESULTS

All three RSP surgeries were performed through the single incision without adding extra umbilical ports or 2‐mm instruments. For RP, the operative duration was 5 h and the estimated blood loss was 250 mL. The hospital stay was 36 h and the margins of resection were negative. For pyeloplasty, the operative duration was 4.5 h, and the hospital stay was 50 h. Right radical nephrectomy for a 5.5‐cm renal cell carcinoma was performed in 2.5 h and the hospital stay was 48 h. The specimen was extracted intact within an entrapment bag through the umbilical incision. There were no intraoperative or postoperative complications. At 1 week after surgery, all patients had minimal pain with a visual analogue score of 0/10.

CONCLUSIONS

Technical challenges of single‐port surgery that may limit its widespread acceptance can be addressed by using robotic technology. Articulation of robotic instruments may render obsolete the long‐held laparoscopic principles of triangulation especially for intracorporeal suturing. We report the initial series of robotic surgery through a single transumbilical incision.     

Feasibility of a novel extraperitoneal two‐port laparoendoscopic approach for radical prostatectomy: An initial study

The aim of this study was to describe the surgical technique and to report the early outcomes of an original extraperitoneal two‐port laparoendoscopic approach for radical prostatectomy. A total of 22 consecutive patients diagnosed with early‐stage prostate cancer (cT1c, cT2N0) were operated on and included in this analysis. A multichannel port with three 5‐mm trocars, providing easier instrument handling, was inserted extraperitoneally through a 2.5‐cm lower umbilical “U” incision. An additional 12‐mm port was inserted into the left fossa to allow an adequate working angle to facilitate the most critical steps of the surgical procedures. The operation was successfully completed in all patients; one patient required an additional 5‐mm port to control bleeding. The median operation time was 259 min (range 207–453 min), and the fluid loss, including urine and blood, was 946 mL (range 257–1821 mL). The median Foley catheter indwelling period was 6 days (range 3–11 days) after surgery. No intraoperative complications occurred. Judging from this initial trial, this procedure can be safely carried out if the surgeon is familiar with conventional five‐port laparoscopic radical prostatectomy.     

Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis

Aim We present our initial experience of a single port laparoscopic total proctocolectomy with ileoanal J pouch anastomosis. The single incision laparoscopic surgery (SIL), (Covidien, Norwalk, Connecticut, USA) device with a multichannel cannula and specially designed curved laparoscopic instrumentation were used. Method A patient with familial adenomatous polyposis underwent restorative proctocoectomy. A colonoscopy had demonstrated nearly 1000 polyps in the colon with several 1‐cm polyps in the rectum. The abdomen was entered through a 2.5 cm incision sited preoperatively for the temporary ileostomy. The single port device was inserted and a total proctocolectomy was performed. Ligation of the vessels was performed with the Ligasure (Covidien). The colon and rectum were extracted through the SIL site. An 18‐cm ileoanal J pouch was created extracorporeally. The pouch anal anastomosis was performed intracorporeally and a diverting loop ileostomy created through the SIL port site. Results The operating time was 172 min. Blood loss was 100 ml and the hospital stay was 4 days without any complication. The patient had a virtually scar‐less abdomen other than the site of the loop ileostomy. Conclusion Single port laparoscopic surgery may allow complex colorectal surgery to be performed resulting in a virtually scar‐less procedure.     

‘LESS’ radical prostatectomy: a pilot feasibility study with a personal original technique

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Laparoendoscopic single‐site surgery (LESS) provides the ability to perform major surgery with minimal incisions and nearly scar‐free results. A pure single port laparoscopic radical prostatectomy has been previously described as a feasible but challenging procedure with a high complications’ rate. We describe a modification of the single‐port laparoscopic radical prostatectomy, using a periumbilical multichannel port plus a second port placed in the left iliac fossa with the aim of having an adequate working angle during the most critical steps of the procedure. This minimally invasive technique is a safe procedure and appears to be a good compromise between a pure single multichannel port and a standard multitrocar laparoscopic approach.

OBJECTIVE

We evaluated the feasibility and the potential advantages of a modification of the single‐port laparoscopic radical prostatectomy using a periumbilical multichannel port plus a second port placed in the left fossa with the aim of having an adequate working angle during the most critical steps of the procedure.

PATIENTS AND METHODS

Between March and September 2009 we operated on five patients with early‐stage prostate cancer (T1c) and a normal body mass index (<25). The procedure was carried out with a specially‐designed multichannel trocar which contains two 5 mm and one 10 mm ports plus a 5 mm port placed in the left iliac fossa in order to have an adequate working angle. The first two patients received a nerve sparing radical prostatectomy.

RESULTS

All cases were completed successfully in a mean operative time of 225 minutes (range 210–250) with blood losses of less than 100 ml. All patients were discharged from the hospital in 3rd postoperative day and the catheter was always removed seven days from surgery. No intraoperative complications occurred. The pathological tumour stage revealed pT2bNo prostate cancer in all five cases without positive surgical margins. After a mean follow‐up of 4 months (range 1–7) all patients have an undetectable prostate‐specific antigen level and no postoperative early major complications. The first two patients were fully continent respectively after 3 and 8 weeks after surgery, the third patient uses one safety pad after three month from surgery. The last two patients have a moderate incontinence and are currently under rehabilitation. Regarding potency the first patient had intercourses without any therapies after two months from surgery while the second one (6 months follow up) has partial penile tumescence using oral vardenafil.

CONCLUSION

Two ports laparoscopic radical prostatectomy is feasible in very selected cases. However, our pilot study should be still considered a technical report and the limits of the technique must still be defined in a larger population and by other investigators.     

经脐单孔腹腔镜保胆取石术的应用体会(附8例报告)

目的:探讨经脐单孔腹腔镜保胆取石术治疗胆囊结石的可行性、手术方法及应用价值.方法:回顾分析为8例胆囊结石患者行经脐单孔腹腔镜保胆取石术的临床资料.结果:8例手术均顺利完成,患者均恢复良好,手术时间45～90 min,平均62 min;术中出血量10～20 ml,平均15 ml,术后住院2～3 d.术后均未使用止痛药,无...     

Heilbronn laparoscopic radical prostatectomy. Technique and results after 100 cases

INTRODUCTION: In 1999, Guillonneau and Vallancien presented a refined approach of a descending laparoscopic radical prostatectomy which based mainly on the primary access to the seminal vesicles and an improved suturing and knotting technique. Based on our own experience reconstructive laparoscopy as well as with open retropubic radical prostatectomy we have used a combined ascending/descending technique similar to open surgery. In this paper we want to describe our approach and to present the initial results with the Heilbronn technique. MATERIALS AND METHODS: A transperitoneal approach is used with a W-shaped arrangement of the trocars (13-mm umbilical port, 2 x 10 mm medial, 2 x 5 mm lateral ports). After the exposure of the Retzius' space and control of the dorsal vein complex the urethra is incised and the distal pedicles of the prostate (+/- the neurovascular bundle) are transsected. We now pull the apex ventrally and start with the incision at the bladder neck followed by a transvesical access to both vasa deferentia and seminal vesicles. The gland is entrapped in the Extraction Bag. After accomplishing the posterior wall of the urethrovesical anastomosis with five interrupted sutures, the foley catheter is placed into the bladder and the bladder neck is closed. Now the prostate is extracted via the umbilical incision. From March 1999 to June 2000, we have performed 100 cases (48 pT2-, 47 pT3- and 5 pT4 tumors). The mean preoperative PSA was 26.8 (1.4-75.5) ng/ml. Two tumors were grade 1, 72 grade 2 and 26 grade 3. Median Gleason score was 6 (3-9). All specimen were inked and examined according to the Stanford protocol. Postoperative continence was evaluated using a questionnaire monitored by a colleague who was involved in surgery. RESULTS: We had 5 conversions (rectal injury, difficult dissection, adhesion, 2x bleeding at the dorsal vein complex). The mean operating time was 278 (180-500) min., the transfusion rate 31%. One patient required reintervention due to bleeding from the right obturator fossa. 95% of the patients did not require any analgesia on the second postoperative day. Positive margins were found in 17% of the patients, of which 12 had a PSA nadir to a value of less than 0.1 ng/ml within 3 weeks after surgery. In 82 patients, the anastomosis was tight after removal of the catheter, median catheter time was 8 (6-30) days. 4% developed a stricture at the anastomotic site which could be treated by laser incision. On discharge 33% were continent, after 6 months 81%, whereas only 2 patients still suffer from grade II stress incontinence at 9 months. CONCLUSIONS: Laparoscopic radical prostatectomy is feasible but requires laparoscopic expertise. Its learning curve is still ongoing. Morbidity is low, oncological control is similar to results of open surgery, functional results are promising.     

Laparoskopische Single-Port-Chirurgie

As essentially all operations performed with open laparotomy can be completed with minimal access, surgeons and industry continue to push the boundaries of minimally invasive surgery. New and controversial approaches, such as natural orifice translumenal endoscopic surgery (NOTES) and single incision or single port surgery are being explored with the goal of reduced surgical morbidity. The fundamental idea of single port surgery is therefore to minimize the number of abdominal wall incisions and allow access for all laparoscopic instruments through one skin incision. Several techniques in use require specialized equipment with multiple ports through one umbilical incision or one multichannel port. For single port surgery to be widely adopted surgeons must demonstrate safety, efficacy and reproducibility of the technique across a wide range of patients and clinical scenarios. In order to meet these requirements concerns about well-founded surgical training and quality monitoring must be addressed as with any major technical advance.     

Experiencia inicial en prostatectomía radical laparoscópica con el dispositivo de acceso laparoscópico umbilical Single-Incision Laparoscopic Surgery Port®

Since 2007, various urological procedures have been performed with laparoendoscopic single-site surgery (LESS surgery), including nephrectomy, pyeloplasty, simple prostatectomy and, with the refinement of laparoscopic instrumentation, radical prostatectomy. This paper reports our initial experience in radical prostatectomy using the SILS? Port from Covidiem and two lateral 5-mm trocars for triangulation. The SILS? Port allows for accurate, simple insertion through a Hadson incision. The flexible port accomodates three 5-mm cannulas or two 5-mm cannulas and a 12-mm port for easier instrument exchange through a single incision. This approach decreases morbidity from bleeding, hernia and/or internal organ damage and improves cosmetic results.One-port single-incision laparoscopy is part of the natural development of minimally invasive surgery. Future research is required to assess the intraoperative and postoperative benefits of LESS surgery as compared to standard laparoscopy.     

单孔腹腔镜直肠癌Dixon切除术的技巧

The efficacy of laparoscopic Dixon operation for the treatment of rectal cancer has been proven,while at the same time there are opportunities to make the procedure less invasive.From January 2010 to March 2011,9 cases of single access laparoscopic Dixon operation have been performed at the Shengjing Hospital.An incision with the length of 3 cm was created in umbilicus and 3 trocars were inserted through the fascia on the abdominal wall.The dissection and anastomosis were performed through the incision.The resected tumors were removed through the umbilical incision or anus.The operation was successfully performed on 9 patients,and one more incision with the length of 12 mm was created on the lower abdominal wall in 1 patient in order to install the stapling device.The average operation time was 202 minutes.No postoperative bleeding,intestinal obstruction or anastomosis leakage was found.