Modified Retroperitoneoscopic Port Sites for Surgery of Upper Urinary Tract

BACKGROUND AND OBJECTIVES: Our objective was to introduce our experience using modified retroperitoneoscopic port positions for operations of the upper urinary tract. METHODS: We designed different trocar positions or incisions according to different surgical procedures and specimen sizes. A total of 116 patients, comprising patients with common adrenal, kidney, and ureter diseases, underwent retroperitoneoscopic operations by use of modified incisions. These patients comprised 23 with adrenal diseases, 84 with kidney diseases, and 9 with ureter diseases. The specimen was retrieved, as much as possible, through a transverse incision to produce a hidden scar after recovery. By contrast, 143 patients underwent the same or similar procedures using classical 3-port incisions. The operative time was defined as the time from skin incision to skin closure. RESULTS: There were no significant differences in age, estimated blood loss, oral intake, and hospital stay between groups. A significant difference in favor of the modified group was noted with respect to analgesia use (diclofenac sodium, 50 mg vs 100 mg; P < .05) in all 3 modified methods, as well as in cosmetic outcome in the groups undergoing the first modification (score, 8.9 ± 2.2 VS 7.3 ± 2.8; P < .05) and second modification (score, 8.7 ± 2.5 VS 7.1 ± 2.4; P < .05). In addition, the mean operative time in patients undergoing ureter operations was shorter than that in the conventional group using classical 3-port positions (55 ± 11 minutes vs 70 ± 15 minutes, P < .05). CONCLUSIONS: Our modified retroperitoneoscopic incision is a safe, cosmetic alternative procedure for operations of the upper urinary tract. Different diseases and specimen sizes can be treated with the personalized or suitable incisions that we have introduced.