Urologic robot-assisted laparoendoscopic single-site surgery using a homemade single-port device: A single-center experience of 68 cases

Purpose: To describe our experience with robot-assisted laparoendoscopic single-site (R-LESS) surgeries and evaluate a homemade port system as an effective access technique. Patients and Methods: Between May 2009 and April 2010, 68 consecutive R- LESS urologic operations were performed in our institution. A 4 to 5 cm long incision was made over the umbilicus. After the inner ring of the Alexis wound retractor was placed into the peritoneum, a common size 7 surgical glove was then applied over the external side of the wound retractor. A homemade single port was established by inserting two 12-mm trocars and two 8-mm trocars through fingers of a surgical glove and securing it to the port. Results: Sixty-eight patients underwent R-LESS, including partial nephrectomy in 51, nephroureterectomy in 12, radical nephrectomy and adrenalectomy in 2 each, and simple nephrectomy in 1. Mean patient age was 56 years (range 16-81 y). Mean body mass index was 23.9 kg/m ² (range 17.2-32.9 kg/m ²). The mean operative time was 219 minutes (range 109-382 min). Mean estimated blood loss 319 mL (range 50-1550 mL), and change in hematocrit was 5.2 % (range 0.0-14.8%). At a mean follow-up of 8 months, there were no port-related complications, and cosmesis was excellent. Conclusions: R-LESS is feasible and can be safely applied to a variety of urologic operations, considering the low intraoperative complication rate. Our homemade single-port device provides adequate range of motion and is more flexible in port placement for R-LESS than the current multichannel port.