V869: Nephroureterectomy by Single Incision Laparoscopic Surgery

Video

Introduction and Objectives
Since the first laparoscopic surgery in urology in 1990s, it has been used for treatment of a variety of urologic disorders. The benefits are well recognized & known to everyone. Single Incision Laparoscopic Surgery (SILS) is a progression in technologic advances with a aim to achieve these advantages a step further. We present a case of 55 yr female with Lt flank pain. Investigation revealed a dysmorphic, non-functioning kidney with Gd 4 VUR. SILS nephro-ureterectomy was performed transperitoneally.

Methods
With patients in 70-degree lateral position, through a 2cm periumblical incision, a Size 7 surgical glove was inserted. Two 5mm ports & one 10 mm port were introduced through the fingers of the glove. The procedure was carried out using regular laparoscopic working instruments, scope & camera. Standard Nephroureterctomy was done. The specimen was removed via the umbilical incision, intact. A 18 Fr drain was left in place and fixed through the periumbilical incision.

Results
The duration of surgery was 130 min. The blood loss was minimal (30ml). No blood transfusion was required. The drain was removed on POD2. Pt did not require post-op analgesia. She was discharged on POD3, with return to normal activity after 3 days.

Conclusions
Single Incision Laparoscopic Surgery (SILS) is an emerging sub-specialty of Lap-urology gaining acceptance & popularity very quickly. Till date, publications have shown that the results of SILS in urology are promising and have been at least comparable to standard surgery. Further technological advances with regards to instrumentation and retraction should facilitate implementation of this surgical platform and improve the learning curve thus allowing more urologists to feel comfortable with it, especially reconstructive surgeries. Although SILS nephrectomy may offer a subjective cosmetic advantage, validated patient-outcome questionnaires are necessary to more objectively address this end point. Prospective comparison between SILS and conventional laparoscopic nephrectomy is needed to more clearly define its role.

Funding: none