Retroperitoneal laparoscopic single-site nephroureterectomy: Initial operative experience.
BACKGROUND
Our aim was to describe our early experience with laparoendoscopic single-site surgery (LESS) via the retroperitoneal approach for upper urinary tract tumors.


METHODS
Since April 2010, 21 patients with upper urinary tract cell carcinoma were treated by our team: 12 patients have undergone LESS nephroureterectomy and 9 have undergone standard retroperitoneal laparoscopic surgery. In our LESS procedure, we employed a bendable grasper in the non-dominant hand and a standard straight laparoscopic instrument in the dominant hand. Nephrectomy was performed using procedures similar to those of conventional laparoscopic nephrectomy. In standard laparoscopic nephroureterectomy, the distal ureter and bladder cuff were excised by using the open method.


RESULTS
All operations using retroperitoneal LESS nephroureterectomy were completed without conversion to standard laparoscopy or open surgery. No intraoperative or acute postoperative complications occurred. We compared the results of the retroperitoneal single-port laparoscopic surgery group to the standard retroperitoneal laparoscopic surgery group and found that the retroperitoneal LESS nephroureterectomy had significantly less estimated blood loss (P = 0.034). No significant difference was noted with respect to age, BMI, operation time, time to oral intake, length of hospitalization, and the visual analog pain scale score at discharge ( P > 0.05).


CONCLUSIONS
The initial reports of retroperitoneal LESS nephroureterectomy demonstrate that the technique is a safe and feasible procedure for upper urinary tract urothelial carcinoma.
Department of Urology, The University of Kyorin, Tokyo, Japan. toke@ks.kyorin-u.ac.jp
Takatsugu
T
Okegawa
Naoshi
N
Itaya
Hidehiko
H
Hara
Kikuo
K
Nutahara
Eiji
E
Higashihara
D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*