title: Transvesical laparoendoscopic single site surgery to remove surgical materials penetrating the bladder: initial clinical experience in 9 female patients.
abstract: OBJECTIVE
  The optimal approach for removing surgical materials that have penetrated the bladder is still debatable. We reviewed our initial experience with transvesical (percutaneous intraluminal access) laparoendoscopic single site surgery to treat such complications. We determined the safety, efficacy and morbidity of the procedure.
  
  
  METHODS
  In this case series study 9 women 24 to 63 years old were operated on from November 2009 to July 2012 due to bladder tape/mesh or surgical suture extrusion using the transvesical (percutaneous intraluminal access) laparoendoscopic single site surgery approach. We used the TriPort™ or TriPort+ single site access system, and a combination of straight and articulating or only standard laparoscopic instruments. A running V-Loc™ suture was placed as needed. In all cases followup included urine tests, abdominal ultrasound and cystoscopy.
  
  
  RESULTS
  Mean operative time was 59 minutes (range 35 to 105). Median postoperative hospital stay was 2.4 days. No blood loss or complications were observed except 1 conversion to open surgery because of a perivesical abscess. No extra port was added. No adverse events related to the method were observed during the mean 19-month followup. In 1 patient mesh extrusion recurred after 12 months of followup.
  
  
  CONCLUSIONS
  We consider this technique to be an efficient, safe procedure and a valuable minimally invasive treatment option for foreign body removal from the bladder. However, further observations are needed to prove the validity of the method.
authors.affiliation: Department of Urology, Medical University of Gdańsk, Gdańsk, Poland. mroslan@esculap.pl
authors.forename: Marek
authors.initials: M
authors.lastname: Roslan
authors.forename: Marcin M
authors.initials: MM
authors.lastname: Markuszewski
mesh_terms: D000328:Adult; D003558:Cystoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007049:Iatrogenic Disease; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D053825:Suburethral Slings / Q000009:adverse effects; D013526:Surgical Mesh / Q000009:adverse effects; D015503:Surgical Sponges / Q000009:adverse effects; D053832:Surgical Tape / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: LESS; T-LESS; UTI; complications; device removal; iatrogenic disease; laparoendoscopic single site surgery; slings; transvesical (percutaneous intraluminal access) LESS; urinary bladder; urinary tract infection