Abstract
Introduction:
Donor nephrectomy with laparoendoscopic single-site (LESS) surgery has been reported via the transperitoneal approach. The umbilicus (e-NOTES [embryological Natural Orifice Translumenal Endoscopic Surgery]) is a popular site, but leaves a nasty scar, and extraction of the kidney may be complex, risking warm ischemic renal injury. Our units have a combined experience of around 300 retroperitoneal donor nephrectomies and therefore want to offer single-site surgery to our patients.
Materials and Methods (including a description of the video):
We operated on two men on the right side (body mass index 32 and 33 kg/m2). We made a single 6-cm surgical incision in the right groin, below the abdominal skin crease, and developed the retroperitoneum under direct vision before using an inflation balloon behind the kidney. Using Gelport™ and bariatric/curved laparoscopic instruments, gas pressure was maintained and Gerota's fascia opened. Normal triangulation is maintained as the edges of the Gelport is used for a 5- and 12-mm port as well as camera port. The vena cava and renal artery is seen early. The angle of dissection makes vessel stapling easy. The LESS groin incision offers superior cosmesis.
Results:
The operative times were 4 and 5 h, warm ischemic times 135 and 315 sec, blood loss 100 and 250 mL, and hospitalization 3 and 2 days, respectively. Graft function was good during the early postoperative period.
Conclusions:
Retroperitoneal LESS donor nephrectomy through a single groin incision is feasible and safe and may be a step toward the perfect minimal access donor operation. Further evaluation of the technique in a larger patient cohort is underway.
All authors have declared no conflicts of interest exist.
Runtime of video: 6 mins 59 secs
Keywords
Get full access to this article
View all access options for this article.