Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter
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ORIGINAL ARTICLE
Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter Ning Kang • Jun-hui Zhang • Yi-nong Niu • Jian-wen Wang • Xi-quan Tian • Yan Yong • Nian-zeng Xing
Received: 9 May 2012 / Accepted: 25 September 2012 / Published online: 10 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval ureter and our initial experience with this method in 4 patients. Methods From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand
N. Kang J. Zhang Y. Niu J. Wang X. Tian Y. Yong N. Xing (&) Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing 100020, China e-mail: [email protected]
suturing. A double-pigtail ureteral stent assembly was implanted in 3 of the 4 patients. Results All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The mean operating time was 105 min (range, 90–135 min). The mean blood loss was 18 mL (range, 5–50 mL). None of the patients required blood transfusion. The double-pigtail ureteral stent was removed 4–6 weeks postoperatively. The mean postoperative hospital stay was 7.3 days (range, 6–9 days). No intraoperative or postoperative complications occurred. At a mean follow-up of 10 months, excellent improvement in the ureteral obstruction was observed. Conclusions We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term followup of more cases is needed to confirm its benefits. Keywords Retroperitoneal laparoscopic single-site surgery LESS Retrocaval ureter
N. Kang e-mail: [email protected]
Introduction
J. Zhang e-mail: [email protected]
In recent years, urologists have worked to develop techniques to make laparoscopic surgery less invasive. Since the introduction of laparoendoscopic single-site (LESS) surgery in 2007 [1, 2] dramatic improvements in this approach have been achieved. As new techniques and instruments have become available, LESS has found increasing use in diverse urological diseases and many medical centers now have extensive experience with LESS urologic surgery [3, 4]. From October 2009 to June 2012, at our institution, L
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