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Purpose: To objectively evaluate surgically induced astigmatism (SIA) after phacotrabeculectomy using keratometry and topography and to compare the magnitude of SIA and the refractive outcomes of single-site and twin-site phacotrabeculectomies.Methods: Forty prospective subjects were enrolled in the study and were randomized into single-site and twin-site cohorts. SIA was objectively assessed using keratometry and Orbscan before and at three months after surgery. For both cohorts, the changes in SIA were assessed using power vector analysis compared at the third month after surgery.Results: Each cohort consisted of 20 eyes. The preoperative parameters and postoperative IOP were comparable and similar, respectively, in both the cohorts (P = 0.1). Majority of the patients in both the cohorts had preoperative against-the-rule (ATR) astigmatism. The median change in SIA at the three-month postoperative visit was similar in both the cohorts, with a small increase in ATR astigmatism. Although the SIA change measured by keratometry in the J0 component was similar in both the groups (P = 0.54), that of J45 was significantly different (P = 0.01). However, the median change in SIA was similar in both the groups for both the J0 (P = 0.52) and J45 components (P = 0.94) when measured by Orbscan. The SIA in both the groups measured with keratometry (P = 0.62) and topography (P = 0.52) were clinically and statistically similar. In both the groups, the refraction was similar at 1 month and 3 months.Conclusion: The SIA as measured with keratometry and topography was similar in the single-site and twin-site phacotrabeculectomy cohorts at the end of 3-months. The postoperative refraction was stabilized in 1-month in both the groups. [ABSTRACT FROM AUTHOR]

Objectives: To perform a survey of the current state of laparoendoscopic single-site surgery (LESS) and its implementation in the treatment of malignant disease of the urinary tract. Although it is a recent development in the field of laparoscopic surgery with still unproven long-term results, LESS may prove to be more commonly performed in the coming years while managing urologic cancer patients. Materials and Methods: A PubMed search was conducted using the key words laparoendoscopic single-site surgery, LESS, urologic cancer. Relevant articles were reviewed for data on the management of urologic malignancy with LESS. Results: The first articles describing LESS for urologic cancers were published in 2007. Since then, published experience with this technique has increased. LESS has been implemented as an alternative to conventional laparoscopic surgery and open surgery for the treatment of major urologic cancers. The proposed advantages of LESS are the aesthetic benefit of a single incision and a quicker and less painful recovery. Disadvantages are the lack of instrument triangulation, instrument clashing and the steeper learning curve. As this is a fairly recent technical innovation, long-term functional and oncological results for LESS have not yet been published. Conclusions: LESS is a novel technical advance over conventional laparoscopic surgery, and it can be successfully used in the treatment of patients with urologic cancers. Published data support the feasibility and safety of LESS interventions for major urologic cancers, and newer data may assist in finding LESS's ultimate position among therapeutic options for patients with urologic malignancies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laparoendoscopic single-site surgery (LESS) has recently been applied successfully in the performance of a host of surgical procedures. Preliminary consensus from the experts is that this mode of surgery is technically challenging and requires expertise. The transition from trainee to practicing surgeon, especially in complex procedures with challenging learning curves, takes time and mentor-guided nurturing. However, the trainee needs to use platforms of training to gain the skills that are deemed necessary for undertaking the live human case. OBJECTIVE: This article aims to demonstrate a step-by-step means of how to acquire the necessary instrumentation and build a training model for practicing steeplechase exercises in LESS for urological surgeons and trainees. The tool built as a result of this could set the platform for performance of basic and advanced skills uptake using conventional, bent and articulated instruments. A preliminary construct validity of the platform was conducted. MATERIALS AND METHODS: A box model was fitted with an R-Port™ and camera. Articulated and conventional instruments were used to demonstrate basic exercises (e.g. glove pattern cutting, loop stacking and suturing) and advanced exercises (e.g. pyeloplasty). The validation included medical students (M), final year laparoscopic fellows (F) and experienced consultant laparoscopic surgeons (C) with at least 50 LESS cases experience in total, were tested on eight basic skill tasks (S) including manipulation of the flexible cystoscope (S1), hand eye coordination (S2), cutting with flexible scissors (S3), grasping with flexible needle holders (S4), two-handed maneuvers (S5), object translocation (S6), cross hand suturing with flexible instruments (S7) and conduction of an ex-vivo pyeloplasty. RESULTS: The successful application of the box model was demonstrated by trainee based exercises. The cost of the kit with circulated materials was less than £150 (Pounds Sterling). The noncamera handling skills (S2-S8) of the ex-vivo training model for LESS can distinguish between laparoscopically naïve fellows and experienced consultants in LESS. S4-S8 showed the highest level of construct validity, by accurately differentiating among the M, F and C groups. CONCLUSION: LESS requires a significant amount of skill and has an inherent steep learning curve. The ex-vivo model described provides a cost-effective means that a trainee or training unit can build for optimising preliminary skill acquisition in LESS for urological trainees. It has construct validity in several tasks. Such platform models should be tested further with an emphasis on rapid sequence uptake of optimal skills, prior to undertaking the live human case. [ABSTRACT FROM AUTHOR]

Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings. [ABSTRACT FROM AUTHOR]