Laparoendoscopic single-site (LESS) nephroureterectomy and en bloc resection of bladder cuff with a novel extravesical endoloop technique

Objective: To present the initial experience of laparoendoscopic single-site (LESS) nephroureterectomy via the transperitoneal approach using the Alexis wound retractor and bladder cuff resection by endoloop. Methods: Two patients received LESS nephroureterectomies and bladder cuffs resection with homemade single ports, which were created by using an Alexis wound retractor as an access platform through a 4-cm incision. Distal ureters were resected through the same incision with endoloop. No additional ports were used and both procedures were completed successfully. Results: Both LESS procedures were completed successfully without traditional laparoscopic conversion or complication. LESS nephreoureterectomy with bladder cuff excision was performed in 165 and 325 minutes with estimated blood loss of 30 and 65 mL, respectively. Patients were discharged on postoperative days 3 and 7, respectively. Conclusions: The initial results demonstrated that LESS technique of nephroureterectomy and bladder cuff resection with endoloop is a safe and feasible procedure for urothelial carcinoma of upper urinary tract.