time was 233 min (180-310), blood loss 365ml (50-800). There were no intraoper- ative complications, one Clavien-Dindo- grade IIIb (bladder neck stenosis) and onegrade II (symptomatic UTI). Conclusions: Hybrid LESS RP is safe and feasible with short-term oncological and functional outcomes comparable to our 4 ports technique. VID-04.05 A Novel Intracorporeal Knotting Technique for Laparoendoscopic Surgery Grange P 1 , Rouse P 1 , Rao A 1 , Kype A 2 1 Kings College Hospital; 2 UCH Education Centre, London, UK Introduction and Objective: Laparoen- doscopic Single Site (LESS) urological pro- cedures aregaining popularity across the globe. Most reported series/case reports of reconstructive LESS urological proce- dures such as partial nephrectomy and pyeloplasty describe the use of an addi- tional port (2-5mm) to aid dissection and to accomplish an intra-corporeal knot. We will demonstrate with this high-definition video, a step-by-step guide to achieve complete intra-corporeal knotting tech- nique on the box trainer and subse- quently the application of this technique to complex urological reconstructive pro- cedures, in this case of laparoscopic par- tial nephrectomy. Materials and Methods: Initial design of the knotting technique and proof of con- cept was on a box trainer. A commer- cially available single port device along with the needle holder and a grasper are used to demonstrate the knotting tech- nique. Along with the video, clear illustra- tions that can be easily understood and reproduced by others will be shown. We have since applied this technique for com- plex LESS reconstructive procedures such as no-clamp partial nephrectomy and py- eloplasty. Results: As demonstrated in the illustra- tions and the video, step one of the knot- ting involves the needle within the needle holder to rotate three times in a clock- wise direction. This forms three loops around the shaft of the needle holder. The needle is then transferred across to the grasper, which frees the needle holder to grasp the short end of the su- ture. The knot is tightened by a push and pull method as opposed to the horizontal method that can be achieved in the tradi- tional multiport laparoscopic technique. The knot is further secured by repeating the above steps in the opposite direction. Conclusions: We have demonstrated with the video demonstration a complete intra-corporeal knotting technique that can be utilized without the need for any additional port or clip devices achieving LESS procedure. This technique will be useful for pure LESS procedures such as such as partial nephrectomy, pyeloplasty and other reconstructive urological opera- tions. VID-04.06 NOTES Hybrid Transvaginal Upper Pole Heminephrectomy De Andrade R 1 , Carmona O 1 , Ramirez D 1 , Giedelman C 1 , Herrera E 1 , Canes D 2 , Aron M 3 , Desai M 3 , Gill I 3 , Sotelo R 1 1 Instituto Medico La Floresta, Caracas, Venezuela; 2 Lahey Institute of Urology At Parkland Medical Center, Burlington, MA, USA; 3 University of Southern California, Institute of Urology, Los Angeles, USA Introduction and Objective: Duplica- tion of the ureter and renal pelvis is the most common anomaly of the upper uri- nary tract. Upper pole heminephrectomy is a treatment option when duplication anomalies are associated with ureteral ec- topia or ureterocele with an associated nonfunctioning or infected upper pole moiety. We describe a NOTES hybrid transvaginal upper pole heminephrectomy in a 24 year-old with recurrent infections in a poorly functioning right upper pole moiety. Materials and Methods: The procedure was performed with a bariatric trocar in the vagina, and a multichannel single-port device (Triport, Olympus Surgical) in the umbilicus. The colon was mobilized. Both ureters were identified. The upper pole ureter was traced to the upper pole. The ureter was transected and released from behind the hilar vasculature. Vascu- lar supply to the upper pole was identi- fied and divided. Ultrasonic scalpel was used for heminephrectomy. The specimen was retrieved through the vagina. Results: Operative time was 150 minutes. Blood loss was 50cc. After one week, pa- tient developed urinoma at the surgical site, and was reexplored laparoscopically. The cut edge of the heminephrectomy defect was fulgurated and a drain placed. The patient recovered uneventfully follow- ing re-exploration. Conclusions: Hybrid NOTES transvaginal heminephroureterectomy is feasible. Hav- ing both the transvaginal and umbilical ports restores much needed triangulation, while still achieiving a virtually scar free result. The hybrid approach serves as a safe stepping-stone towards pure NOTES procedures. VID-04.07 Laparoscopic Management of Incisional Hernias at the Site of Extraction after Robotic Prostatectomy Sotelo R 1 , Giedelman C 1 , Saavedra J 1 , Arriaga J 1 , De Andrade R 1 , Carmona O 1 , Garza R 1 , Parra E 1 , Canes D 2 1 Instituto Medico La Floresta, Caracas, Venezuela; 2 Lahey Institute of Urology at Parkland Medical Center, Burlington, MA, USA Introduction: Robot-assisted laparo- scopic radical prostatectomy is now in widespread use for the management of organ-confined prostate cancer. Although complications are uncommon, incisional hernias at extraction site have been re- ported and their impact on morbidity can be serious. For development of incisional hernia there are personal and physical risk factors, and those related with the surgi- cal technique. The overall incidence of hernias in the trocar site is around 0.65 to 2.8%. Usually, the camera port placed 1-2cm above the umbilicus is enlarged to accommodate the size of the prostate to be removed, which increases the risk. We report our experience in the diagnosis and management of incisional hernias af- ter robot-assisted laparoscopic radical prostatectomy. Materials and Methods: We recorded operative and postoperative data on 275 patients who underwent robot-assisted laparoscopic radical prostatectomy at our institution from 2007 to 2010, who pre- sented incisional hernias by the site of extraction of the surgical specimen or in VID-04.04, Table 1. Histology Margin negative positive pT2c 14 0 pT3a 2 1 pT3b 1 1 Disease volume 15.5 % (1-30) Disease mass 8.7 g (0.5-21) PSA f-up All PSA 0.1 at X months (1-17) Continence (no pad) 66% 3-months 100% 6-months 100% 12-months VIDEO SESSIONS UROLOGY 78 (Supplement 3A), September 2011 S167