Laparoscopic single-incision triangulated umbilical surgery (SITUS) pyeloplasty: a description of the first 32 cases.

INTRODUCTION AND OBJECTIVES: Transumbilical laparoendoscopic (LESS) procedures reduce access trauma. Laparoendocopic single-incision triangulated umbilical surgery (SITUS) utilizes straight instruments in a triangulated fashion, via three trocars placed through a single umbilical incision. METHODS: Thirty-two consecutive patients underwent an SITUS pyeloplasty. Access is performed by incision of the umbilical fold by 3/4 of its circumference, a 5-mm camera port, and consequently, cranial and caudal 3 or 5 mm working trocars are placed at a distance of 3-6 cm, thus allowing triangulation. SITUS laparoscopy utilizes the standard straight instruments with a length of 43 cm. RESULTS: All procedures were successfully performed and no conversion to open, or conventional laparoscopic approach was deemed necessary. Thirty patients underwent a dismembered and two a Fenger pyeloplasty. A crossing vessel was identified in 68.75% of the cases. The median laparoscopic and suturing times were 130 and 30 min, respectively; median blood loss was 50 ml. The median duration of hospitalization was 4 days. The visual analogue scores (VAS) reported were 1 on the first and 0 on the third postoperative day. The indwelling double-J or mono-J stents were removed after a median time of 5 weeks and 4 days, respectively. The overall success rate was 96.8%. CONCLUSIONS: The SITUS technique for pyeloplasty is an attractive alternative to conventional laparoscopy and a viable competitor to LESS surgery. It combines the common principles of traditional laparoscopy, such as conventional instrumentation and triangulation, with the benefits of single-port surgery.

Uncovering the real outcomes of active renal stone treatment by utilizing non-contrast computer tomography: a systematic review of the current literature.

PURPOSE: To evaluate the stone-free rates (SFRs) and stone clearance rates (SCRs) of extracorporeal shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolitholapaxy (PCNL) according to non-contrast computer tomography (NCCT) findings. METHODS: Original articles were identified from PubMed. After exclusion of ineligible papers, twenty-three studies with 2494 cases were included in the review. RESULTS: Six SWL, five RIRS and eight PCNL studies were selected. Additionally, four comparative articles were identified. SWL presents SFRs ranging 35-61.3 % and SCRs for residuals <4 mm being 43.2-92.9 %. RIRS studies report SFRs of 34.8-59.7 % and SCRs for residuals <4 mm ranging 48-96.7 %. Finally, PCNL presents SFRs of 20.8-100 % and SCRs for residuals <4 mm being 41.5-91.4 %. According to the comparative studies, SFRs are 17-61.3 % for SWL, 50 % for RIRS, and 95-100 % for PCNL. CONCLUSIONS: According to NCCT findings, it seems that PCNL provides better SFRs than ESWL and RIRS. However, further research with comparable and complete preoperative parameters and outcomes could reduce the heterogeneity of current data.