[Transvesical laparoendoscopic single-site approach for repair of urinary tract injuries after vaginal or pelvic surgery].
OBJECTIVE
To present a one-center clinical experience of using the transvesical laparoendoscopic single-site surgery (T-LESS) to repair selected urinary tract injuries after vaginal or pelvic surgery.


METHODS
From November 2009 to August 2013, 22 women underwent the treatment with the use of the T-LESS technique to repair various complications after gynecologic or uro-gynecologic surgery. Thirteen patients were operated on for iatrogenic foreign bodies, 8 patients underwent a vesicovaginal fistula repair and 1 woman a ureteral reimplantation due to ureterovaginal fistula. In all cases, the TriPort system was established intravesically and standard laparoscopic instruments were used. When needed, bladder and vaginal wall defects were closed with barbed V-Loc suture.


RESULTS
The treatment was successful in all patients. In one case the procedure was converted to open approach. No blood loss or complications were observed. Mean operative time was 78 min. and mean hospitalization time was 3.6 days. The postoperative pain was 0.7 (Visual Analogue Scale) on postoperative day 1. During the average follow-up of 78 months no adverse events related to the method except for one small asymptomatic mesh erosion were noticed.


CONCLUSIONS
The T- LESS approach for repair of selected urinary tract injuries after vaginal or pelvic surgery is a feasible, efficient and safe procedure. It offers excellent visualization inside the bladder, availability of intracorporeal watertight suturing and minimal postoperative pain. Nevertheless, substantial development of the instruments and further investigations are necessary to assess the usefulness of this technique.
Marek
M
Roslan
Marcin
M
Markuszewski
D000328:Adult; D000368:Aged; D005260:Female; D005547:Foreign Bodies / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007049:Iatrogenic Disease; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010388:Pelvis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D014551:Urinary Tract / Q000293:injuries; D014570:Urologic Diseases / Q000209:etiology / Q000601:surgery*; D014621:Vagina / Q000601:surgery; D014945:Wound Healing