Abstract
Introduction
New transumbilical laparoendoscopic procedures are an emerging field in urologic surgery. We introduced the concept of single-incision triangulated umbilical surgery (SITUS) in 2009. SITUS technique uses straight optics and instruments in a triangulated fashion via three trocars placed through an umbilical incision resulting in a familiar laparoscopic environment. Aim of the study was to demonstrate the feasibility of SITUS in simple and radical nephrectomy in daily routine.
Materials and methods
From October 2009 to July 2010, in 3 patients with cirrhotic kidneys a simple and in 12 patients a radical nephrectomy was performed in SITUS technique. The umbilical fold was incised at three-fourth of its circumference; in the patient with radical nephrectomy, additionally small “c”-shaped skin flaps were removed. After achieving a pneumoperitoneum by Verres technique, a 5-mm camera port and then a cranial 5 mm and a caudal 11 mm working trocar were placed with at a distance of 5–10 cm with the aid of two Langenbeck hooks, thus allowing triangulation except in the radical nephrectomy patients, where an 11-mm caudal trocar (Endopath, Ethicon, Hamburg, GER) was used. Using long conventional laparoscopic instruments, En-Seal pressure coagulator and dissector (Erbe, Tuebingen, Germany), Hem-O-Lock clips (Weck, Teleflex, USA), and a 30° 5-mm optic (Karl Storz, Tuttlingen, GER), the interventions were executed like conventional laparoscopic transperitoneal procedures.
Results
OR time was mean 127 min [120, 153] for cirrhotic kidney nephrectomy group and mean 137 min [91, 185] in the radical nephrectomy group. Mean hemoglobin drop was 1.5 g/dl [1.2, 1.7] in benign cases and 2.4 [1.1, 4.9] in radial nephrectomies. All except one diabetic patient with wound infection had an uneventful follow-up without postoperative complications. The patients were discharged at postoperative day 5 [3, 29].
Conclusion
SITUS technique for simple and radical nephrectomy is an attractive alternative to conventional laparoscopy and single-port surgery. It combines the common principles of traditional laparoscopy (straight instruments and triangulation) with single-port surgery (cosmesis and minimally invasiveness) resulting in adequate or time and short learning curve.
Similar content being viewed by others
References
Raman JD, Cadeddu JA, Rao P, Rane A (2008) Single-incision laparoscopic surgery: initial urological experience and comparison with natural-orifice transluminal endoscopic surgery. BJU Int 101(12):1493–1496
Box G, Averch T, Cadeddu J, Cherullo E, Clayman R, Desai M, Frank I, Gettman M, Gill I, Gupta M, Haber GP, Kaouk J, Landman J, Lima E, Ponsky L, Rane A, Sawyer M, Humphreys M (2008) Urologic NOTES working group. Nomenclature of natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) procedures in urology. J Endourol 22(11):2575–2581
Stolzenburg JU, Kallidonis P, Till H, Burchardt M, Herrmann TR, Liatsikos EN (2009) Current status of laparoendoscopic single-site surgery in urology. World J Urol 27(6):767–773
Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D, Desai MR, Rao PP, Sotelo R, Stein R, Gill IS (2009) Laparoendoscopic single-site surgery: initial 100 patients. Urology 74(4):805–812
Nagele U, Walcher U, Kugler M, Imkamp F, Merseburger AS, Burchardt M, Kuczyk MA, Herrmann TRW (2010) Single incision triangulated umbilical surgery (SITUS). Eur Urol Suppl 9(2):244
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC (2010) European association of urology guideline group. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406
Stolzenburg JU, Hellawell G, Kallidonis P, Do M, Haefner T, Dietel A, Liatsikos EN (2009) Laparoendoscopic single-site surgery: early experience with tumor nephrectomy. J Endourol 23(8):1287–1292
Hagen ME, Wagner OJ, Christen D, Morel P (2008) Cosmetic issues of abdominal surgery: results of an enquiry into possible grounds for a natural orifice transluminal endoscopic surgery (NOTES) approach. Endoscopy 40(7):581–583
Stolzenburg JU, Kallidonis P, Oh MA, Ghulam N, Do M, Haefner T, Dietel A, Till H, Sakellaropoulos G, Liatsikos EN (2010) Comparative assessment of laparoscopic single-site surgery instruments to conventional laparoscopic in laboratory setting. J Endourol 24(2):239–245
Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA (2007) Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 70:1039–1042
Park YH, Park JH, Jeong CW, Kim HH (2010) Comparison of laparoendoscopic single-site radical nephrectomy with conventional laparoscopic radical nephrectomy for localized renal-cell carcinoma. J Endourol 24(6):997–1003
Aaron M, Canes D, Desai MM, Haber GP, Kaouk JH, Gill IS (2009) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103:516–521
Raman JD, Bagrodia A, Cadeddu JA (2009) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison perioperative outcomes and short-term measures of convalescence. Eur Urol 55:1198–1206
Liatsikos E, Rabenalt R, Burchardt M, Backhaus MR, Do M, Dietel A, Wasserscheid J, Constantinides C, Kallidonis P, Truss MC, Herrmann TR, Ganzer R, Stolzenburg JU (2008) Prevention and management of perioperative complications in laparoscopic and endoscopic radical prostatectomy. World J Urol 26(6):571–580
Stolzenburg JU, Kallidonis P, Hellawell G, Do M, Haefner T, Dietel A, Liatsikos EN (2009) Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur Urol 56(4):644–650
Makhoul B, De La Taille A, Vordos D, Salomon L, Sebe P, Audet JF, Ruiz L, Hoznek A, Antiphon P, Cicco A, Yiou R, Chopin D, Abbou CC (2004) Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic versus open nephrectomy. BJU Int 93(1):67–70
Fahlenkamp D, Rassweiler J, Fornara P, Frede T, Loening SA (1999) Complications of laparoscopic procedures in urology: experience with 2,407 procedures at four German centers. J Urol 162(3 Pt 1):765–770
Rassweiler J, Fornara P, Weber M, Janetschek G, Fahlenkamp D, Henkel T, Beer M, Stackl W, Boeckmann W, Recker F, Lampel A, Fischer C, Humke U, Miller K (1998) Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German urologic association. J Urol 160(1):18–21
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Nagele, U., Walcher, U. & Herrmann, T.R.W. Initial experience with laparoscopic single-incision triangulated umbilical surgery (SITUS) in simple and radical nephrectomy. World J Urol 30, 613–618 (2012). https://doi.org/10.1007/s00345-011-0670-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-011-0670-7