Initial experience with the reusable X-cone single port system for laparoscopic urologic procedures (SIU 2011)

  • uploaded: Sep 18, 2011
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Sep 18, 2011 / Duration: 03:32 / Views: 108 / 0 comments

Authors:

Florian Fuller

Institution:

Department of Urology, Charité University Hospital, Berlin, Germany
Categories:

Abstract

Introduction and Objective: LESS is gaining popularity for minimally invasive urologic procedures. Despite the known benefits of LESS, most systems use disposable material, thus reducing cost effectiveness. We tested the applicability of the newly developed reusable X-Cone system for basic urologic procedures.

Materials and Methods: We herein present our initial experience with the Storz® X-Cone single port system for pelvic lymphadenectomy (PL; n=8) in prostate cancer patients prior to radiation therapy, for marsupilalization of large renal cysts (CM; n=2), for simple nephrectomy (NE; n=2) of non-functional atrophic kidneys and for left varicocelectomy in adults (VE; n=12). The Storz® X-Cone single port consists of two L-shaped steel half shells that are connected to an autostatic X-shaped funnel. A silicone rubber cap with four 5 mm and one 12.5 mm working channels is used for sealing. A rigid 5 mm 30° laparoscope is used together with a curved and a straight laparoscopic instrument. A second curved instrument can be inserted for static retraction.

Results: Mean follow-up was 12 weeks. Mean patient age and BMI was 73 years and 28 in the PL group, 66 years and 27 in the CM group, 64 years and 27 in the NE group and 26 years and 24 in the VE group. A transumbilical incision was used in the PL and VE group. A medioclavicular paraumbilical incision was used in the CM and NE group. The incisional length was approx. 5 cm for NE and 2.5 cm for all other procedures. Mean operating time was, 109 min for PL, 67 min for CM, 121 min for NE and 47 min for VE. Blood loss was < 50 ml for all procedures. In PL and NE an additional 3 mm port was routinely used. In one case of NE conversion to conventional laparoscopy was necessary due to CO2 leakage at the port insertion site. In the PL group the average yield of pelvic lymph nodes was n=10. In the VE group the testicular artery was preserved. No postoperative complications occurred and cosmetic outcomes were favorable in all patients. Hospital stay was 1 day in the VE group and 2 days in all other groups. Technical limitations include CO2-leakage through the 5 mm working channels and crowding of instruments while using a second curved grasper for static retraction.

Conclusion: The reusable Storz® X-Cone single port is safe, easy to handle and cost effective for standard urologic procedures. Minor technical flaws need to be addressed before expanding the use of this promising LESS system.

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