Port placement for pneumovesical laparoscopic surgery reduces operative time and technical burden: A novel technique

Purpose: Pneumovesical laparoscopic ureteral reimplantation is a standard surgical option for vesicoureteral reflux. Owing to the flexibility of the bladder wall, penetration using a trocar is difficult, particularly for beginners. Improper port placement results in a substantially increased operative time and sometimes requires open conversion. Thus, we established a novel technique for introducing a trocar through the bladder wall using the Funada-kit II device (Create Medic, Kanagawa, Japan), which was initially developed for gastrostomy. This study aimed to describe our new technique using the Funada-kit II and compare the time required for port placement with that of a conventional method. Materials and methods: We performed pneumovesical laparoscopic surgery in 36 patients (18 men and 18 women; mean age, 14.5 years; range, 2–60 years) between April 2012 and March 2023. Since 2018, the Funada-kit II has been used to fix the anterior bladder wall to the abdomen, and it was subsequently used to secure trocars. Surgical video data were analyzed to calculate the time required for each port placement and were compared with those of the conventional method. Results: The mean time for port placement using the new technique was significantly shorter than that using the conventional technique (4.67 ± 2.14 and 18.18 ± 9.84 min, respectively; P < 0.0001). Conclusion: Port placement was shorter when using the Funada-kit II, and we believe that the kit will be an effective alternative to standard techniques.