Yonsei Med J.  2011 Mar;52(2):307-313. 10.3349/ymj.2011.52.2.307.

Laparoendoscopic Single-Site Nephrectomy Using a Modified Umbilical Incision and a Home-Made Transumbilical Port

• Yu HS
• Ham WS
• Rha KH
• Han SW
• Choi YD
• Han WK
• Chang WS

• KMID: 1779668
• DOI: http://doi.org/10.3349/ymj.2011.52.2.307

Abstract

PURPOSE
To assess the clinical utility of laparoendoscopic single-site surgery (LESS) nephrectomy using a modified umbilical incision and home-made transumbilical port in cases requiring extirpative surgery.
MATERIALS AND METHODS
Initial consecutive 18 patients underwent LESS nephrectomies that were performed by a single surgeon. A home-made port was placed through a modified umbilical incision, the length of which had preoperatively been determined. The laparoscopic transperitoneal nephrectomy procedures were performed with various combinations of standard and articulating laparoscopic instruments. Patient characteristics and perioperative outcomes, including pathologic results, were recorded prospectively.
RESULTS
All 18 extirpative surgeries, including simple nephrectomy (eight cases), radical nephrectomy (nine cases), and nephroureterectomy (one case), were completed successfully. The median operation time was 167 min (range 82-220), and the median blood loss was 250 mL (range 0-1050). All specimens were extracted intact through a modified umbilical incision (median length 2.5 cm, range 1.5-6.0). Final pathological analysis revealed a nonfunctioning kidney in five cases, a dysplastic kidney in three cases, a mixed epithelial and stromal tumor in one case, renal cell carcinoma in eight cases (T1: five cases, T3: three cases), and Ta ureter transitional cell carcinoma in one case.
CONCLUSION
LESS nephrectomy using a home-made port and modified umbilical incision is feasible with both minimal incision and cost-effective. Our technique may be more useful for extirpative procedures in which a specimen needs to be removed intact, because incision length can be freely adjusted. Prospective comparisons are warranted to more clearly elucidate the utility of this surgical technique.

Keyword

Laparoendoscopic single-site surgery; nephrectomy; home-made transumbilical port; modified umbilical incision

MeSH Terms

Adult
Aged
Aged, 80 and over
Blood Loss, Surgical
Child
Child, Preschool
Female
Humans
Infant
Kidney Diseases/surgery
Kidney Neoplasms/surgery
Laparoscopy/*methods
Male
Middle Aged
Nephrectomy/*methods
Postoperative Care
Surgical Procedures, Minimally Invasive/methods
Treatment Outcome
Umbilicus/surgery

Figure

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  Fig. 1 Modified umbilical incision with a suitable fasciotomy carried down into the peritoneum. (A) Adult patient. (B) Pediatric patient.

• 

  Fig. 2 Postoperative image of a modified umbilical incision. (A) Adult patient. (B) Pediatric patient.

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