Objectives: To investigate the use of a flexible instrument platform in performing single-port laparoscopic retroperitoneal urologic surgeries and to verify the safety and feasibility of these surgeries. Methods: The homemade instrument platform consisted of two control loops and a powder-free surgical glove to form multichannels. 56 patients underwent this kind of single-port surgery for different urologic diseases, including radical nephrectomy in 31 patients, nephroureterectomy in 7 patients, partial nephrectomy in 8 patients, living donor nephrectomy in 4 patients, adrenalectomy in 3 patients, renal cyst surgery in 2 patients and ureterolithotomy in 1 patient. Results: All surgeries were completed successfully with no switch to conventional laparoscopic or open surgery. The mean hospital stay was 13.13 days (range 6-36). All patients were satisfied without major complications. Conclusions: Retroperitoneal laparoendoscopic single-site surgery using our cost-effective homemade instrument platform appears to be a feasible and safe surgical strategy to perform retroperitoneal laparoscopic urologic surgery.

1.
Steinberg AP, Finelli A, Desai MM, Abreu SC, Ramani AP, Spaliviero M, Rybicki L, Kaouk J, Novick AC, Gill IS: Laparoscopic radical nephrectomy for large (greater than 7 cm, T2) renal tumors. J Urol 2004;172:2172-2176.
2.
Taylor GD, Cadeddu JA: Applications of laparoscopic surgery in urology: impact on patient care. Med Clin North Am 2004;88:519-538.
3.
Tracy CR, Raman JD, Cadeddu JA, Rane A: Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 2008;5:561-568.
4.
Desai MM, Rao PP, Aron M, Pascal-Haber G, Desai MR, Mishra S, Kaouk JH, Gill IS: Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU Int 2008;101:83-88.
5.
Lowry PS, Moon TD, D'Alessandro A, Nakada SY: Symptomatic port-site hernia associated with a non-bladed trocar after laparoscopic live-donor nephrectomy. J Endourol 2003;17:493-494.
6.
Marcovici I: Significant abdominal wall hematoma from an umbilical port insertion. JSLS 2001;5:293-295.
7.
Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, Kaouk JH, Gill IS: Transumbilical single-port surgery: evolution and current status. Eur Urol 2008;54:1020-1029.
8.
Kaouk JH, Haber GP, Goel RK, Desai MM, Aron M, Rackley RR, Moore C, Gill IS: Single-port laparoscopic surgery in urology: initial experience. Urology 2008;71:3-6.
9.
Saito K, Kihara K, Kawakami S, Fujii Y, Masuda H, Koga F: Gasless two port access total nephroureterectomy: MIES total nephroureterectomy. Eur Urol Suppl 2010;9:335.
10.
Gill IS, Canes D, Aron M, Haber GP, Goldfarb DA, Flechner S, Desai MR, Kaouk JH, Desai MM: Single port transumbilical (E-NOTES) donor nephrectomy. J Urol 2008;180:637-641, discussion 641.
11.
Goel RK, Kaouk JH: Single port access renal cryoablation (SPARC): a new approach. Eur Urol 2008;53:1204-1209.
12.
Kihara K: Application of gasless laparoendoscopic single port surgery, GasLESS, to partial nephrectomy for renal cell carcinoma: GasLESS-clampless partial nephrectomy as a multiply satisfactory method. Int J Urol 2012;19:3-4.
13.
Joseph RA, Salas NA, Donovan MA, Reardon PR, Bass BL, Dunkin BJ: Single-site laparoscopic (SSL) cholecystectomy in human cadavers using a novel percutaneous instrument platform and a magnetic anchoring and guidance system (MAGS): reestablishing the ‘critical view'. Surg Endosc 2012;26:149-153.
14.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
15.
Zhu H, Shen C, Li X, Xiao X, Chen X, Zhang Q, Wang H, He Z, Zhou L: Laparoscopic pyeloplasty: a comparison between the transperitoneal and retroperitoneal approach during the learning curve. Urol Int 2013;90:130-135.
16.
Fan X, Xu K, Lin T, Liu H, Yin Z, Dong W, Huang H, Huang J: Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. BJU Int 2013;111:611-621.
17.
Hagen ME, Wagner OJ, Christen D, Morel P: Cosmetic issues of abdominal surgery: results of an enquiry into possible grounds for a natural orifice transluminal endoscopic surgery (NOTES) approach. Endoscopy 2008;40:581-583.
18.
Piskun G, Rajpal S: Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 1999;9:361-364.
19.
Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA: Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 2007;70:1039-1042.
20.
Zeltser IS, Bergs R, Fernandez R, Baker L, Eberhart R, Cadeddu JA: Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model. J Urol 2007;178:288-291.
21.
Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, Lima E, Montorsi F, Richstone L, Stolzenburg JU, Kaouk JH: Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 2011;59:26-45.
22.
Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D, Desai MR, Rao PP, Sotelo R, Stein R, Gill IS: Laparoendoscopic single-site surgery: initial hundred patients. Urology 2009;74:805-812.
23.
Jeon HG, Jeong W, Oh CK, Lorenzo EI, Ham WS, Rha KH, Han WK: Initial experience with 50 laparoendoscopic single site surgeries using a homemade, single port device at a single center. J Urol 2010;183:1866-1871.
24.
Raman JD, Bagrodia A, Cadeddu JA: Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 2009;55:1198-1204.
25.
Andonian S, Rais-Bahrami S, Atalla MA, Herati AS, Richstone L, Kavoussi LR: Laparoendoscopic single-site Pfannenstiel versus standard laparoscopic donor nephrectomy. J Endourol 2010;24:429-432.
26.
Canes D, Berger A, Aron M, Brandina R, Goldfarb DA, Shoskes D, Desai MM, Gill IS: Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 2010;57:95-101.
27.
Han WK, Park YH, Jeon HG, Jeong W, Rha KH, Choi H, Kim HH: The feasibility of laparoendoscopic single-site nephrectomy: initial experience using home-made single-port device. Urology 2010;76:862-865.
28.
Ryu DS, Park WJ, Oh TH: Retroperitoneal laparoendoscopic single-site surgery in urology: initial experience. J Endourol 2009;23:1857-1862.
29.
Lee SW, Lee JY: Laparoendoscopic single-site urological surgery using a homemade single port device: the first 70 cases performed at a single center by one surgeon. J Endourol 2011;25:257-264.
30.
Afaneh C, Ramasamy R, Leeser DB, Kapur S, Del PJ: Is right-sided laparoendoscopic single-site donor nephrectomy feasible? Urology 2011;77:1365-1369.
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