Laparoscopic augmentation enterocystoplasty through a single trocar.
OBJECTIVE
To report on the initial case and surgical technique of laparoendoscopic, single-site, subtotal cystectomy and augmentation enterocystoplasty performed through a single multichannel transumbilical port in a patient with neurogenic bladder.


METHODS
Laparoendoscopic, single-site, subtotal cystectomy and augmentation enterocystoplasty was performed in a 20-year-old woman with neurogenic bladder secondary to congenital sacral lipoma that had been operated on at 2 years of age. The patient had a long history of urinary incontinence and frequent and urgent urination. The imaging and urodynamic studies revealed a 100-mL bladder capacity with thickened walls, countless diverticula, and low compliance. The procedure was performed exclusively using a novel multichannel access port. Additional instruments included the 5-mm video laparoscope, SonoSurge, and flexible scissors. Subtotal cystectomy was initially performed by resecting 70% of the bladder. The ileal loop was exteriorized through the single port by detaching the valve, and the ileal pouch and bowel continuity were restored extracorporeally. The vesicoileal anastomosis was performed laparoscopically.


RESULTS
The operating time was 300 minutes, and the blood loss was <100 mL. No intraoperative or postoperative complications developed. The hospital stay was 6 days. The drain and Foley catheter were removed at 7 and 21 days postoperatively, respectively. Postoperative cystography confirmed a watertight anastomosis and increased bladder capacity. At last follow-up, the patient was performing intermittent self-catheterization to complete emptying.


CONCLUSIONS
Our initial experience with laparoendoscopic, single-site, subtotal cystectomy and enterocystoplasty through a single port was encouraging. The use of the larger diameter port significantly facilitated extracorporeal bowel reconstruction and can be used for various minimally invasive surgical procedures.
Noguera
Rene J Sotelo
RJ
Centro de Cirugía Robótica y Mínimamente Invasiva, Unidad de Urología, Instituto Médico La Floresta, Caracas, Venezuela. renesotelo@cantv.net
Astigueta
Juan C
JC
Carmona
Oswaldo
O
De Andrade
Robert J
RJ
Luis
Sanchez
S
Cuomo
Bernardo
B
Manrique
Javier
J
Gill
Inderbir S
IS
Desai
Mihir M
MM
D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult