Surgical Techniques in Urology Laparoendoscopic Single-site Transvesical Ureteroneocystostomy for Vesicoureteral Reflux in an Adult: A One-year Follow-up Marek Roslan, Marcin M. Markuszewski, Jakub Kla ˛ cz, and Kazimierz Krajka INTRODUCTION Various minimally invasive techniques have been developed to decrease morbidity related to laparoscopic port placement and to improve cosmetic results while maintaining the same standards and efficacy of surgical care. One such approach is laparoendoscopic single-site surgery. We describe our initial clinical experience of using this technique for transvesical ureteral reimplantation. TECHNICAL CONSIDERATIONS The procedure was performed transvesically (percutaneous intraluminal approach) with a single- port device (3-channel) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm laparoscope was used with either straight or articulating instruments. The ureter was dissected, shortened, passed through the submucosal tunnel, and fixed in place with a running absorbable V-Loc suture. The operative time was 250 minutes. No significant bleeding or other complications were observed. CONCLUSION Although further development of the instruments and skills is needed laparoendoscopic single- site surgery transvesical reimplantation of the ureter appeared to be feasible and safe. Neverthe- less, further experience and observations are necessary. UROLOGY 80: 719 –723, 2012. © 2012 Elsevier Inc. O ver the past decade, laparoscopy has been dem- onstrated to be a valid approach in a variety of surgical procedures, resulting in lower perioper- ative morbidity, shorter hospital stays, and consequent improvement in the quality of life of the patient. Re- cently, efforts have been made to further decrease the morbidity related to laparoscopic port placement and to improve cosmetic results without sacrificing standards of surgical care. Minilaparoscopic approaches have been developed, including laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic sur- gery (NOTES). 1,2 Compared with conventional laparos- copy, LESS reduces the number of ports needed and could therefore reduce postoperative morbidity, unfavor- able cosmesis, and prolonged hospital stays. There are numerous applications of LESS for urologic indications, including either reconstructive or ablative procedures. 3,4 Simple prostatectomies as well as diverticulectomies have been performed transvesically via the single-port placed intraperitoneally through an intraumbilical incision. 3,5 A few reports describe the LESS technique performed per- cutaneously, directly through the bladder wall for foreign body removal, bladder cuff excision, or adenomec- tomy. 6-8 Despite the fact that such minimally invasive treatment has evolved over recent years and was subse- quently introduced for most urologic indications, only several series of laparoscopic approaches for treating vesi- coureteral reflux (VUR), either in adults or in children, have been published. 9,10 We were able to find only one report on LESS extravesical ureteral reimplantation for VUR. 11 Here, we describe our experience with transvesical ureteral reimplantation using the TriPort device (Olym- pus Winter & IBE GMBH, Hamburg, Germany) inserted directly into the bladder. To the best of our knowledge, this is the first report of a transvesical LESS approach for VUR repair in an adult. MATERIAL AND METHODS Medical History A 39-year-old woman with recurrent flank abdominal pain, chronic urinary tract infection, urinary frequency, and nocturia was referred to our department in May 2010. The patient had experienced these symptoms for several years and had repeat- edly refused operative treatment. The patient took this position despite being informed of the likely long-term consequences. Numerous courses of antibiotics were administered previously without success. Ultrasonography, intravenous pyelography, and voiding cys- tourethrography (VCUG) revealed grade V bilateral VUR (Fig. 1A–C). In addition, microbiological examinations indicated Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Medical University of Gdan ´sk, Gdan ´sk, Poland Reprint requests: Marek Roslan, M.D., Ph.D., Department of Urology, Medical University of Gdan ´sk, ul. Kliniczna 1A, 80-402 Gdan ´sk, Poland. E-mail: mroslan@ esculap.pl Submitted: March 4, 2012, accepted (with revisions): June 13, 2012 © 2012 Elsevier Inc. 0090-4295/12/$36.00 719 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2012.06.028