title: Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases.
abstract: OBJECTIVE
  Laparoscopic endoscopic single-site surgery (LESS) has recently emerged as an attempt to enhance cosmetic benefits and reduce morbidity; however, LESS for radical cystectomy is still not well established. Here we describe the technique of hybrid LESS for radical cystoprostatectomy and orthotopic ileal neobladder (RC-OIN), and evaluate its feasibility and safety.
  
  
  METHODS
  Between November 2008 and October 2009, 12 men with bladder cancer underwent hybrid LESS for RC-OIN. A homemade multichannel port, made from two stretchable rings and a surgical glove with trocars and valves attached to its fingers, was placed into a 4- to 5-cm midline incision in the lower abdomen and was used for laparoscopic instruments. Another subumbilical port was placed for the laparoscope. Extended bilateral pelvic lymphadenectomy was performed by the lateral view; radical cystoprostatectomy was completed laparoscopically; construction of the ileal neobladder was performed extracorporeally; and the neobladder was anastomosed to the urethral stump laparoscopically, with a slipknot running suture technique. Perioperative, functional, oncologic data and complications were collected and analyzed.
  
  
  RESULTS
  All operations were performed successfully without conversion to conventional laparoscopic radical cystectomy or open surgery. There was no perioperative mortality or port-related complications. The median operative time was 383 minutes. Median blood loss was 150 mL. A median of 25 lymph nodes were removed. Surgical margins were tumor free in all cases.
  
  
  CONCLUSIONS
  Hybrid LESS for RC-OIN is technically feasible with effects similar to those of conventional laparoscopic procedures. Further instrument and technique improvement are necessary to shorten operative time and reduce intraoperative difficulties.
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Tianxin
authors.initials: T
authors.lastname: Lin
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
authors.forename: Jinli
authors.initials: J
authors.lastname: Han
authors.forename: Kewei
authors.initials: K
authors.lastname: Xu
authors.forename: Hai
authors.initials: H
authors.lastname: Huang
authors.forename: Chun
authors.initials: C
authors.lastname: Jiang
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Caixia
authors.initials: C
authors.lastname: Zhang
authors.forename: Yousheng
authors.initials: Y
authors.lastname: Yao
authors.forename: Wenlian
authors.initials: W
authors.lastname: Xie
authors.forename: Arvind Kumar
authors.initials: AK
authors.lastname: Shah
authors.forename: Li
authors.initials: L
authors.lastname: Huang
mesh_terms: D000368:Aged; D039021:Colonic Pouches; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D012725:Sexual Behavior; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery