www.kjurology.org DOI:10.4111/kju.2011.52.6.431 Case Report Laparoendoscopic Single-Site Surgery (LESS) for Excision of a Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis Ki Don Jang, Kyung Hwa Choi, Seung Choul Yang, Won Sik Jang, Ji Young Jang, Woong Kyu Han Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea We report a case of laparoendoscopic single-site surgery (LESS) for a symptomatic left seminal vesicular cyst and ipsilateral renal agenesis. A 49-year-old man presented with a 1-year history of severe irritation upon voiding and intractable, recurrent hemato- spermia. A computed tomography scan showed a 68x41x38 mm sized left seminal vesic- ular cyst with ipsilateral renal agenesis. LESS was performed successfully to treat the seminal vesicle cyst. The total operative time was 125 minutes, and blood loss was mini- mal. The patient was discharged from the hospital on the second postoperative day. Key Words: Cysts; Laparoscopy; Minimal access surgical procedures; Seminal vesicles This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, dis- tribution, and reproduction in any medium, provided the original work is properly cited. Article History: received 15 February, 2011 accepted 18 April, 2011 Corresponding Author: Woong Kyu Han Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea TEL: +82-2-2228-2323 FAX: +82-2-312-2538 E-mail: hanwk@yuhs.ac Seminal vesicular cysts associated with ipsilateral renal agenesis are exceedingly rare. Seminal vesicular cysts are usually asymptomatic, but occasionally cause perineal pain, post-ejaculatory pain, hematospermia, infertility, and voiding symptoms [1,2]. Existing treatment methods for symptomatic seminal vesicular cysts include trans- rectal aspiration, transurethral unroofing, transurethral resection of the ejaculatory duct, transurethral endoscopic examination and aspiration, open surgery [3], and trans- seminal vesiculoscopic fenestration [4]. However, the first four of these methods may be associated with a risk of cyst recurrence and infection [3]. As a result, the current treat- ment of choice remains operative excision, although the evolution of surgical techniques and instruments has en- abled successful laparoscopic cyst excision [1,2]. We per- formed and report here a laparoendoscopic single-site sur- gery (LESS) on a seminal vesicular cyst associated with ir- ritable voiding symptom and intractable hematospermia. This study was approved by the institutional review board of Yonsei Severance hospital in Korea. CASE REPORT A 49-year-old man presented with a 1-year history of void- ing symptoms (frequency, nocturia, and reduced force of urinary stream) and intractable recurrent hematospermia. A digital rectal examination revealed a large, mobile, non- Korean Journal of Urology Ⓒ The Korean Urological Association, 2011 tender, soft cystic lesion in the area of the left seminal vesi- cle. A pelvic computed tomography (CT) scan showed a cyst- ic lesion, measuring 68x41x38 cm, situated on the seminal vesicle and ipsilateral renal agenesis. No and other abnor- malities were visible on the CT scan (Fig. 1). Routine blood and urinary laboratory studies were normal. According to the diagnosis of a symptomatic seminal vesicular cyst, we recommended excision of the cyst. After deciding on surgi- cal excision of the seminal vesicular cyst, we decided to per- form LESS to excise the cyst to obtain better cosmesis. The patient provided informed consent to undergo the surgery. 1. Surgical procedure While under general anesthesia, the patient was placed in the Trendelenburg position, padded, and secured to the op- erating table. For transperitoneal LESS, a 3 cm skin in- cision was made at the umbilicus. We used an extra small Alexis wound retractorⓇ (Applied Medical, Rancho Santa Margarita, CA, USA) and a surgical glove as the homemade single-port device. The first, second, third, and fifth glove fingers were secured, with sutures and a rubber band, to the ends of four channels of a multichannel trocar with re- spective diameters of three 12 mm trocars (Laport, Sejong, Seoul, Korea) and one 5 mm trocar. Created as such, this device can provide a single port similar to that of a commer- cial multichannel trocar, whereby the wound retractor sta- bilizes the device in the umbilical incision. The inner ring 431 Korean J Urol 2011;52:431-433