To report on the initial case and surgical technique of laparo-endoscopic single site (LESS) subtotal cystectomy and augmentation enterocystoplasty performed through a single multichannel transumbilical port.

LESS subtotal cystectomy and augmentation ileocystoplasty was performed in a 20 year old female with neurogenic bladder. The patient had long history of urinary incontinence, frequent and urgent urination, and repeated urinary infections. Imaging studies and urodynamics revealed 100 cc bladder capacity with thickened walls, countless diverticules and low compliance. The procedure was performed exclusively via a novel multichannel access port that had four 12 mm access channels (QuadPort). Additional instruments included a 5 mm videolaparoscope, SonoSurge, and flexible scissors. Subtotal cystectomy was initially performed by resecting 70% of the bladder. The ileal loop was exteriorized through the single-port by detaching the valve and the ileal pouch and bowel continuity were restored extracoporeally. The vesico-ileal anastomosis was performed laparoscopically.

Operating time was 300 minutes and blood loss was less than 100 cc. There were no intraoperative or postoperative complications. Hospital stay was 6 days. The drain and the Foley catheter were removed 7 and 21 days after surgery, respectively. Postoperative cystogram confirmed a watertight anastomosis and increased bladder capacity. Patient is performing intermittent self-catheterization to ensure complete emptying.

Our initial experience with LESS subtotal cystectomy and ileo-cystoplasy through a single port is encouraging, indicating technical feasibility of this approach. Use of the larger diameter QuadPort significantly facilitates extracorporeal bowel reconstruction.