830 OUTCOMES OF LAPAROENDOSCOPIC SINGLE SITE PYELOPLASTY: A MULTI-INSTITUTIONAL CUMULATIVE ANALYSIS
Emad RizkalaSoroush Rais‐BahramiRiccardo AutorinoJeffrey A. CadedduAditya BagrodiaVulcan TugcuJihad H. KaoukAkihiro KawauchiAly Abdel-KarimSalah ÉlsalmyDerweesh IthaarArvin K. GeorgeMichael A. LissGeorges‐Pascal HaberLee RichstoneRobert Stein
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You have accessJournal of UrologyTechnology & Instruments: Laparoscopy: Malignant & Benign Disease1 Apr 2013830 OUTCOMES OF LAPAROENDOSCOPIC SINGLE SITE PYELOPLASTY: A MULTI-INSTITUTIONAL CUMULATIVE ANALYSIS Emad Rizkala, Soroush Rais-Bahrami, Riccardo Autorino, Jeffrey Cadeddu, Aditya Bagrodia, Vulcan Tugcu, Jihad Kaouk, Akihiro Kawauchi, Aly Abdel-Karim, Salah Elsalmy, Derweesh Ithaar, Arvin George, Michael Liss, Georges-Pascal Haber, Lee Richstone, and Robert Stein Emad RizkalaEmad Rizkala Cleveland, OH More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami The Arthur Smith Institute for Urology, NY More articles by this author , Riccardo AutorinoRiccardo Autorino Cleveland, OH More articles by this author , Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author , Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Vulcan TugcuVulcan Tugcu Istanbul, Turkey More articles by this author , Jihad KaoukJihad Kaouk Cleveland, OH More articles by this author , Akihiro KawauchiAkihiro Kawauchi Kyoto, Japan More articles by this author , Aly Abdel-KarimAly Abdel-Karim Alexandria, Egypt More articles by this author , Salah ElsalmySalah Elsalmy Alexandria, Egypt More articles by this author , Derweesh IthaarDerweesh Ithaar La Jolla, CA More articles by this author , Arvin GeorgeArvin George The Arthur Smith Institute for Urology, NY More articles by this author , Michael LissMichael Liss La Jolla, CA More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber Cleveland, OH More articles by this author , Lee RichstoneLee Richstone The Arthur Smith Institute for Urology, NY More articles by this author , and Robert SteinRobert Stein Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.397AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single site (LESS) surgery is taking shape as a progressive minimally invasive approach to many urologic procedures. Early published experiences of LESS pyeloplasty (LESS-PP) have reported series of limited sample sizes. We report the outcomes of a large international, multi-institutional series of this procedure. METHODS LESS-PP cases performed between October 2007 and June 2012 at seven institutions worldwide were gathered. Patient characteristics, operative indications, perioperative outcomes, and postoperative follow-up were retrospectively collected and analyzed. RESULTS A total of 151 patients (age 37.5±17.5 years; BMI 24.3±4.5kg/m2; 13.9% with previous abdominal surgery) who underwent unilateral LESS-PP were included. Table 1 highlights the operative results. Mean operative time was 206.8±53.5 minutes with an estimated blood loss of 57.3±45.2 mL. Robotic LESS technique was applied in 31 cases (20.5%). Extra trocars were inserted in 70 (46.4%) cases to complete the procedure. No cases required conversion to open surgery, nor were any intraoperative complications reported. Length of hospital stay was 2.7±1.4 days. The overall 90-day postoperative complication rate was 17.2%, most representing low-grade complications. Compared to preoperative studies where 80.6% had T1/2 greater than 20 minutes, postoperatively, 84.8% of patients demonstrated improved drainage on diuretic nuclear renal scans. There was no significant change in the estimated glomerular filteration rate between pre-op and at a mean of 16.3 months post-operatively. Length of follow-up was 14.6±11 months. CONCLUSIONS Herein, we report the largest series of LESS-PP to date. The procedure appears to be an effective minimally invasive treatment for patients with ureteropelvic junction obstruction, with outcomes similar to those of standard laparoscopy. An additional port may be required to overcome the challenges of suturing through a single access site. For the same reason, the use of a robotic approach can be considered. The lack of a comparative arm and the still limited length of follow-up represent drawbacks to this analysis. Table 1. Intra-operative Results Variables Values ⁎"Operative Time (min) 206.8± 53.5 [75–485] ⁎Estimated Blood Loss (mL) 57.3±45.2 [0-300] Intraoperative Complications 0 Conversion to Conventional Laparoscopy 9 (6) Crossing Vessel Etiology 86 (56.9) Robotic †LESS Employed 31 (20.5) Access Port Type Implemented None (Fascial) 42 (27.8) Gelpoint 40 (26.5) Tri-port 33 (21.9) SILS-Port 32 (21.2) Quad-port 3 (2) Uni-X 1 (0.7) Additional ports None 81 (53.6) 1 64 (42.4) 2 6 (4) Pyeloplasty Technique Dismembered 143 (94.7) Non-dismembered 8 (5.3) Percentages in parentheses. ⁎ Data is represented by the Mean. Ranges in Brackets. † Laparoendoscopic single site © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e340-e341 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Emad Rizkala Cleveland, OH More articles by this author Soroush Rais-Bahrami The Arthur Smith Institute for Urology, NY More articles by this author Riccardo Autorino Cleveland, OH More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Aditya Bagrodia Dallas, TX More articles by this author Vulcan Tugcu Istanbul, Turkey More articles by this author Jihad Kaouk Cleveland, OH More articles by this author Akihiro Kawauchi Kyoto, Japan More articles by this author Aly Abdel-Karim Alexandria, Egypt More articles by this author Salah Elsalmy Alexandria, Egypt More articles by this author Derweesh Ithaar La Jolla, CA More articles by this author Arvin George The Arthur Smith Institute for Urology, NY More articles by this author Michael Liss La Jolla, CA More articles by this author Georges-Pascal Haber Cleveland, OH More articles by this author Lee Richstone The Arthur Smith Institute for Urology, NY More articles by this author Robert Stein Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...Keywords:
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