Single-Port-Access Nephrectomy and Other Laparoscopic Urologic Procedures Using a Novel Laparoscopic Port (R-Port)

doi:10.1016/j.urology.2008.01.078

Urology

Volume 72, Issue 2, August 2008, Pages 260-263

https://doi.org/10.1016/j.urology.2008.01.078 Get rights and content

Objectives

To report an initial clinical urologic experience with a new laparoscopic access port (R-Port) and the advent of the single-port access (SPA) procedure and one-port umbilical surgery (OPUS).

Methods

Five patients underwent therapeutic laparoscopic interventions (two simple nephrectomies for end-stage kidney disease consequent to stone disease, one orchidopexy, one orchidectomy, and one ureterolithotomy), with one R-Port used for each. Three of these procedures were OPUS, and the other two were SPA procedures. In all cases a 5-mm 30° telescope and two 5-mm working instruments were inserted through the port. In the case of the nephrectomies, hemostasis and pedicle control was obtained with the Harmonic Scalpel and Hem-o-lok clips; a novel multi-instrument port cap allowed for safe introduction of a 10-mm clip applier. Frequent instrument changes effected as necessary to allow the operative procedure to proceed to completion did not affect the seal.

Results

All procedures were completed uneventfully. Operative time averaged 83 minutes. There were no perioperative port-related or surgical complications in these cases.

Conclusions

The R-Port allows laparoscopic surgery to be performed safely with fewer ports, thereby allowing for SPA and OPUS with their inherent cosmetic advantages and reduction in postoperative discomfort. More studies are being carried out.

Section snippets

Material and Methods

The R-Port is a U.S. Food and Drug Administration–approved access system comprising a series of devices that can be introduced into defects of any size within the abdominal wall, from a 5-mm incision up to a hand-assisted laparoscopic surgery incision.

Each device consists of a retractor component and a valve component. The retractor component has a distal ring and an outer proximal pair of concentric rings. A doubled-over cylindrical sleeve of film material is fixed to the innermost of the

Results

During surgery all attempts to place the ports were successful and without incident. There were no cases of inadvertent port removal, vascular or visceral trocar injury, loss of pneumoperitoneum, or intraoperative port-site bleeding. After surgery there were no cases of wound hematoma, wound infection, early port-site hernia (at 6 months), or delayed bleeding. Patients were examined at scheduled follow-up appointments at 3 and 6 months, and none were lost to follow-up.

Comment

Conventional trocars have a number of disadvantages when used in laparoscopic surgery. The first of these is that they have a long (normally 10-cm) tube, which substantially encroaches into the abdominal cavity. This means that the visibility achieved through them is limited because the camera must protrude beyond this tube before the surgical field becomes visible. Second, the range of motion of the surgical instrument is curtailed in several ways. Instruments cannot be opened until they are

Conclusions

The R-Port seems to offers surgeons the option of delivering a cosmetically superior, safe outcome using current instrumentation. In selected cases the surgeon creates no new visible scars on the patient, using only the previously scarred umbilicus. More clinical data are needed and are being accrued.

References (12)

C.C. Capelouto et al.
Complications of laparoscopic surgery
Urology
(1993)
P.A. Philips et al.
Abdominal access complications in laparoscopic surgery
J Am Coll Surg
(2001)
J.G. Chandler et al.
Three spectra of laparoscopic entry access injuries
J Am Coll Surg
(2001)
H.M. Hasson
A modified instrument and method for laparoscopy
Am J Obstet Gynecol
(1971)
I.S. Zeltser et al.
Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model
J Urol
(2007)
S. Bhoyrul et al.
Trocar injuries in laparoscopic surgery
J Am Coll Surg
(2001)

There are more references available in the full text version of this article.

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Laparoscopy and RoboticSingle-Port-Access Nephrectomy and Other Laparoscopic Urologic Procedures Using a Novel Laparoscopic Port (R-Port)

Objectives

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Conclusions

Urology

J Am Coll Surg

J Am Coll Surg

Am J Obstet Gynecol

J Urol

Trocar injuries in laparoscopic surgery

J Am Coll Surg

Laparoscopy and Robotic
Single-Port-Access Nephrectomy and Other Laparoscopic Urologic Procedures Using a Novel Laparoscopic Port (R-Port)