title: Ergonomic principles and techniques in facilitating advanced laparoendoscopic single site (LESS) urinary tract reconstruction with conventional laparoscopic instruments.
abstract: OBJECTIVE
  The technical and ergonomic details of laparoendoscopic single site (LESS) reconstruction have not been reported. In this study, we explored the feasibility and safety of performing advanced LESS upper urinary tract reconstruction with conventional laparoscopic instruments.
  
  
  METHODS
  Between September 2010 and March 2011, we retrospectively reviewed prospectively collected data from five patients who underwent LESS urinary tract reconstruction. The LESS reconstruction included pyeloureterostomy (N = 1), dismembered pyeloplasty (N = 2), ureteroneocystostomy (N = 1), and ureteroplasty for bifid blind ending ureter (N = 1). The perioperative and postoperative parameters were collected for analysis. The ergonomic principles and techniques are detailed.
  
  
  RESULTS
  All reconstructive LESS procedures were completed successfully without open conversion or laparoscopic conversion. Ancillary ports or ancillary instruments were not applied in any of the patients. The mean patient age was 40.4 years. The mean operative time was 213 ± 69 minutes, the estimated blood loss ranged from minimal to 50 mL, and the mean hospital stay was 4.4 ± 4 days. No operation-related complication occurred.
  
  
  CONCLUSIONS
  Based on our ergonomic principles and suturing/knotting techniques, conventional laparoscopic instruments are feasible and safe for LESS urinary reconstructive procedures.
authors.affiliation: Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; Department of Urology, Tzu Chi University, Medical College, Hualien, Taiwan. Electronic address: tsai1970523@yahoo.com.tw.
authors.forename: Yao-Chou
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chen-Hsun
authors.initials: CH
authors.lastname: Ho
authors.affiliation: Department of Urology, E-Da Hospital, Kaoshiung, Taiwan.
authors.forename: Victor Chia-Hsiang
authors.initials: VC
authors.lastname: Lin
authors.affiliation: Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
authors.forename: Fu-Shan
authors.initials: FS
authors.lastname: Jaw
mesh_terms: D000328:Adult; D006804:Ergonomics / Q000295:instrumentation*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*
keywords: laparoendoscopic single site (LESS) surgery; laparoscopy; suture technique