Simple Nephrectomy Using the TransEnterix SPIDER ® Surgical System

Abstract

Introduction:

The major drawback of laparoendoscopic single-site surgery (LESS) is the lack of triangulation with the use of rigid instruments. We introduce a video showing the University of Miami application of the TransEnterix SPIDER^® (single-port instrument delivery extended reach) surgical system to facilitate single-port surgery in a case of a simple nephrectomy for an atrophic left kidney. The preparation of the device and the surgical steps are described in this video.

Patient and Methods:

One patient with a nonfunctioning kidney secondary to a ureteropelvic junction obstruction underwent a simple nephrectomy through a single incision performed using the SPIDER surgical system. We placed the SPIDER device via a GelPoint (Applied Medical, Rancho Santa Margarita, CA) and that was positioned through a 4-cm umbilical incision. For vision, we used a rigid 30-degree, 5-mm Karl Storz bariatric endoscope with a right-angled fiber optic light adaptor through one of the two rigid central ports of the SPIDER. We used the SPIDER flexible 5-mm Hem-o-lok clip (Teleflex Medical, Research Triangle Park, NC) appliers to ligate one of the arteries. One extra 12-mm port was placed through the GelPoint for an assistant laparoscopic grasper and 10-mm Hem-o-lok clip application on one of the two renal arteries and a 15-mm Hem-o-lok clip on the renal vein. Harmonic shears (Ethicon Endo-Surgery, Cincinnati, OH) were used through the 12-mm port only for the final step of dissection between the kidney and the adrenal gland through the assistant port. We made no additional skin incisions. The specimen was removed intact through the original incision.

Results:

The SPIDER-LESS nephrectomy was performed without additional skin incisions for laparoscopic ports, instrument clashing, or open conversion. Total operative time was 210 minutes, with blood loss of 50 mL. The patient experienced no intraoperative or postoperative complications. Pathology confirmed benign, atrophic renal parenchyma.

Conclusions:

The SPIDER surgical system LESS nephrectomy is feasible and safe. Studies of the next-generation technology are needed to further optimize its application in urology.

Raymond J. Leveillee: Angiodynamics Inc., Scientific Study; Covidien Inc., Scientific Study/Consultant; Cook, Lecturer; Intuitive Surgical, Proctor; Applied Medical, Lecturer. All other authors: No competing financial interests exist.

Runtime of video: 11 mins 39 secs