title: Initial experience with laparoscopic single-incision triangulated umbilical surgery (SITUS) in simple and radical nephrectomy.
abstract: BACKGROUND
  New transumbilical laparoendoscopic procedures are an emerging field in urologic surgery. We introduced the concept of single-incision triangulated umbilical surgery (SITUS) in 2009. SITUS technique uses straight optics and instruments in a triangulated fashion via three trocars placed through an umbilical incision resulting in a familiar laparoscopic environment. Aim of the study was to demonstrate the feasibility of SITUS in simple and radical nephrectomy in daily routine.
  
  
  METHODS
  From October 2009 to July 2010, in 3 patients with cirrhotic kidneys a simple and in 12 patients a radical nephrectomy was performed in SITUS technique. The umbilical fold was incised at three-fourth of its circumference; in the patient with radical nephrectomy, additionally small "c"-shaped skin flaps were removed. After achieving a pneumoperitoneum by Verres technique, a 5-mm camera port and then a cranial 5 mm and a caudal 11 mm working trocar were placed with at a distance of 5-10 cm with the aid of two Langenbeck hooks, thus allowing triangulation except in the radical nephrectomy patients, where an 11-mm caudal trocar (Endopath, Ethicon, Hamburg, GER) was used. Using long conventional laparoscopic instruments, En-Seal pressure coagulator and dissector (Erbe, Tuebingen, Germany), Hem-O-Lock clips (Weck, Teleflex, USA), and a 30° 5-mm optic (Karl Storz, Tuttlingen, GER), the interventions were executed like conventional laparoscopic transperitoneal procedures.
  
  
  RESULTS
  OR time was mean 127 min [120, 153] for cirrhotic kidney nephrectomy group and mean 137 min [91, 185] in the radical nephrectomy group. Mean hemoglobin drop was 1.5 g/dl [1.2, 1.7] in benign cases and 2.4 [1.1, 4.9] in radial nephrectomies. All except one diabetic patient with wound infection had an uneventful follow-up without postoperative complications. The patients were discharged at postoperative day 5 [3, 29].
  
  
  CONCLUSIONS
  SITUS technique for simple and radical nephrectomy is an attractive alternative to conventional laparoscopy and single-port surgery. It combines the common principles of traditional laparoscopy (straight instruments and triangulation) with single-port surgery (cosmesis and minimally invasiveness) resulting in adequate or time and short learning curve.
authors: Department of Urology and Andrology, LandesKrankenhaus Hall i. T., Milser Str. 10, 6060 Hall i. T., Austria. Udo.Nagele@tilak.at
authors: Udo
authors: U
authors: Nagele
authors: Ute
authors: U
authors: Walcher
authors: Thomas R W
authors: TR
authors: Herrmann
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D005355:Fibrosis / Q000601:surgery; D005858:Germany; D006801:Humans; D007668:Kidney / Q000601:surgery; D007674:Kidney Diseases / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D013525:Surgical Instruments; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery