Video Section

International Braz J Urol
Official Journal of the Brazilian Society of Urology

Vol. 39 (6): 895-896, November - December, 2013
Laparoendoscopic single-site nephroureterectomy for morbid obese patients
Cesar Augusto Braz Juliano, Alexandre Stievano Carlos, Renato Meirelles Mariano Costa Junior, Marcos Tobias-Machado, Antonio Carlos Lima Pompeo
Department of Urology, ABC Medical School (CABJ, RMMCjr, ACLP, MTM), Santo André and Hospital Santa Marcelina (ASC), Sao Paulo, Brazil
Since the first laparoendoscopic single-site (LESS) surgery report in urology in 2007 (1) (Rane A e Cadeddu JA), the few reports of LESS extraperitoneal access in the literature were mainly described for less complex cases. The aim of this video is to demonstrate the feasibility of LESS extraperitoneal access in a morbid obese patient presenting a malignant tumor in the renal pelvis. The patient is positioned in 90-degree lateral decubitus. An incision is made below the abdominal skin crease on the left side of the patient and the anterior rectus fascia is vertically incised with manual dissection of the extra/retroperitoneal space. We use an Alexis® retractor to retract the skin maximizing the incision orifice. Three trocars (12, 10 and 5 mm) are inserted through a sigle-port. The pedicle was controlled “en bloc” with a vascular stapler and the bladder cuff treated by the conventional open approach through the same incision. Operative time was 126 minutes with minimal blood loss. The pathology reported high grade papillary urothelial carcinoma in the pelvis (pT3N0M0) and in the ureter (pTa). LESS extraperitoneal nephroureterectomy is feasible and safe, even in more complex cases. It is a good alternative for morbid obese patients and for patients with synchronous distal ureteral tumors for whom an open approach to the bladder cuff is proposed to avoid incisions in two compartments of the abdominal wall.

Key Words:
Int Braz J Urol. 2012; 39 (Video #15): 895-6