Single-Incision Laparoscopic Anterior Resection with Simultaneous Radical Nephrectomy

Abstract

Background:

Single-incision laparoscopic surgery (SILS) has emerged as a minimally invasive surgery for various intra-abdominal diseases. This modality results in improved cosmetic outcome with the reduced number of incisions. ¹ There have been several reports of cases and early results of SILS in single organ. ^{2 –13} The authors report the first single-incision laparoscopic anterior resection with simultaneous radical nephrectomy.

Methods:

A 52-year-old woman who was waiting for renal transplantation was referred with sigmoid colon cancer and a left renal mass. We used Octoport^TM as single port. A 5-mm flexible laparoscope and a articulating laparoscopic instrument was used in radical nephrectomy. A 5-mm 30°-angled rigid scope and nonarticulating instruments were used in anterior resection. Surgical procedures did not differ much from 5-port laparoscopic surgery for sigmoid colon cancer or conventional laparoscopic radical nephrectomy except that it was conducted through a 3-cm-long single-transumbilical incision. ^{14 –18} End-to-end colorectal anastomosis was made using the double-stapling technique.

Results:

The operative time was 265 minutes, including preparation time between the two procedures. Struggling between the instruments could be minimized using an articulating instrument during radical nephrectomy, but there was still crashing during anterior resection. No intraoperative complication was recorded. Unknown origin of fever was persisted until day 10, although there was no evidence of infected fluid collection on abdomen-pelvic computed tomography. The transumbilical incised site healed completely and left a small scar.

Conclusion:

Single-incision laparoscopic anterior resection with simultaneous nephrectomy can be applicable as a minimally invasive modality. The other simultaneous more than two organs may be considered for patients who need to operate multiple organs. As thought that cosmetic outcome is another important issue, especially in patients such as young women with benign diseases or pediatrics, SILS can be the role for better cosmetic outcome. Further studies are warranted to establish for recommending this technique in a usual clinical setting.

The authors have nothing to disclose.

Runtime of video: 8 mins