Abstract
Introduction:
Laparoscopic radical cystoprostatectomy (LRC) has been demonstrated to be safe and feasible in selected centers. Recently, laparoscopic endoscopic single-site surgery (LESS) has emerged as an attempt to further enhance cosmetic benefits and reduce morbidity. 1 Here we described the technique of hybrid LESS for radical cystoprostatectomy and orthotopic ileal neobladder (RC-OIN) with a homemade multichannel port.
Material and Methods:
Between November 2008 and January 2010, 14 patients with bladder cancer underwent hybrid LESS RC-OIN with a homemade multichannel port. This report details step by step our modified techniques with bilateral extended lymphadenectomy, LRC, construction of ileal neobladder extracorporeally and urethro-pouch anastomosis under laparoscopy. The surgical procedure was similar to conventional LRC. 2 The primary differences included the use of a homemade multichannel port, performing an extended pelvic lymphadenectomy in a lateral view, and appliance of the slipknot suture technique for ligation of dorsal vein complex and urethra-pouch anastomosis. The homemade multichannel port was made by two stretchable rubber rings and a surgical glove. An 8-cm ring was attached to the cuff of glove to act as an outer ring. A 6-cm ring was set at 5–6 cm from the cuff of the glove, and was slipped through the outer ring to form an inner ring. The fingertips of the glove were cut off and fixed with trocars and valves: one 12-mm trocar, one 5-mm trocar, and two rubber valves. The 12-mm trocar provided an access path for CO2, laparoscope, and needle passing. The patients were placed in the Trendelenburg position and a 4–5-cm midline incision was made in the lower abdomen. The multichannel port was placed through the incision. After establishment of the pneumoperitoneum, another port was placed at the umbilicus site under laparoscopic guidance. Extended bilateral pelvic lymphadenectomy was done by lateral view, with the operating side tilted up 15°–30° and the operator and camera holder standing on the other side. A slipknot running suture was performed to facilitate the ligation of dorsal vein complex and urethra-pouch anastomosis. A slipknot was prepared extracorporeally and delivered into the abdominal cavity. After the first stitch, the needle was passed through the hitch of the slipknot, and the hitch was tightened, then the knot was slipped and tightened, and another free-hand knot was made intracorporeally.
Results:
All operations were completed, without conversion to open or conventional laparoscopic surgery. The median operation time was 379 min. Median blood loss was 150 mL. No major intraoperative and postoperative complication occurred. The median number of lymph node removed was 23. Surgical margins were tumor free in all cases.
Conclusions:
Hybrid LESS for RC-OIN with our homemade multichannel port is technically feasible with similar effects to conventional laparoscopic procedure. However, further instrument and technique improvement are necessary to shorten operation time and reduce intraoperative difficulties.
All authors state that no competing financial interests exist.
Runtime of video: 7 mins
