Umbilical laparoendoscopic urological surgery with a novel reusable device.
OBJECTIVE
The aims of this study were to present cumulative experience with umbilical laparoendoscopic urological surgery using a reusable device and to evaluate outcomes and complications in the first 100 patients.


METHODS
Patients undergoing umbilical surgery with the KeyPort system and DuoRotate instruments (Richard Wolf, Knittlingen, Germany) were evaluated prospectively. Demographic, intraoperative and postoperative data were assessed.


RESULTS
Between October 2011 and July 2012, 79 pelvic (66 radical prostatectomy, 10 radical cystectomy, one diverticulectomy, one bilateral orchiectomy, one ureter reimplantation) and 21 renal (seven radical nephrectomy, six partial nephrectomy, five nephroureterectomy, two pyeloplasty, one pyelolithotomy) surgeries were performed through the umbilicus using this platform. Follow-up was 56.7 ± 12.6 weeks (mean ± SD). Mean age was 64.3 ± 10.3 years, body mass index 29 ± 4.6 kg/m(2), operative time 232 ± 106 min and estimated blood loss 260 ± 95 ml. Conversion to standard multiport laparoscopy was not necessary. An accessory port was used in 87 cases to facilitate suturing and conduct drainage extraction. Postoperative complications occurred in 24 cases (six Clavien grade I, 12 grade II, one grade IIIa, two grade IIIb, two grade IVa, one grade IVb). Mean hospital stay was 4.2 ± 4 days. Total transfusion rate was 10%. Mean visual analogue pain scale at day 2 was 2.1 ± 1.3 (0-10). Visual analogue wound satisfaction scale at month 1 was 9.2 ± 0.6 (0-10). No cancer-related events occurred during follow-up. Late complications (4%) were not related to the surgical approach.


CONCLUSIONS
Umbilical KeyPort surgery is technically feasible for a great variety of procedures, both ablative and reconstructive. This access offers adequate surgical outcomes, scarce postoperative pain and security for the patient in the short term. Its reusable nature implies a noticeable economic advantage.
Department of Urology, Hospital Universitario de Getafe, Fundación para la Investigación Biomédica, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid , Madrid , Spain.
Ana
A
García-Tello
Pedro M
PM
Cabrera
Felipe
F
Cáceres
Fernando
F
Ramón de Fata
Erika
E
Mateo
Javier C
JC
Angulo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000295:instrumentation / Q000379:methods; D004389:Durable Medical Equipment; D004867:Equipment Design; D017743:Equipment Reuse; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications; D011446:Prospective Studies; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014472:Umbilicus; D014571:Urologic Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods
LESS; complications; outcomes; umbilicus; urological surgery