Laparoendoscopic Single-Site Bladder Diverticulectomy: Technique and Initial Experience

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Abstract
Purpose: To present our initial experience with the laparoendoscopic single-site surgery (LESS) approach to bladder diverticulectomy. Patients and Methods: Four patients underwent LESS bladder diverticulectomy for the management of diverticula that were associated with persistent symptoms. The median diameter of the diverticula was 8.5 cm (range 4–9 cm). Immediately before, a double-pigtail ureteral catheter was inserted in the ureter on the side of the diverticulum. An 18F urethral catheter was placed via guidewire, and its balloon was inflated into the diverticulum under fluoroscopic control. A TriPort inserted in the umbilicus and a combination of prebent and conventional laparoscopic instruments were used. The balloon inside the diverticulum was inflated and the diverticulum were incised. The diverticulum was dissected circumferentially and removed. Suturing of the bladder lesion followed. The specimen was extracted through the umbilical incision. Perioperative parameters were recorded. Postoperative follow-up included cystography, uroflowmetry, and ultrasonography measurement of postvoid residual urine. Results: Average patient age was 51 years (range 42–66 y) and the average body mass index was 26 kg/m2 (range 23.7–28.7 kg/m2). Average operative time was 130 minutes (range 101–154 min). Blood loss was minimal, with 150 mL the higher loss. Complications were not observed during the follow-up period. The catheter was removed on postoperative day (POD) 8 (n = 3) and on POD 9 (n = 1). Histologic examination did not reveal malignancy. Postoperative pain and analgesic medication requirement were minimal. Conclusions: LESS bladder diverticulectomy proved to be feasible with comparable postoperative outcome to that of the laparoscopic procedure. Further clinical evaluation is deemed necessary.

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