V11-07: Simplified step-by-step surgical principle of right LaparoEndoscopic Single-Site simple nephrectomy
Although laparoendoscopic single site (LESS) nephrectomy was introduced at 2007, it is not widely distributed yet. This video describes simplified step-by-step surgical principle to overcome technical difficulty based on the experience of 100 cases.
The case is 59 years old male with right non-function kidney. With left lateral decubitus position, 3cm vertical incision was made at umbilicus. Hand-made port consisting of two 12 mm port and 5mm working port was installed. First step is to incise the triangular ligament and visceral peritoneum attached to liver and install the intra-organ retractor (IOR) to retract liver for the exposure of the inferior vena cava. Second step is to incise Tolt’s line to retract colon and expose exposure whole IVC under the landmark of the iliac vein originate from IVC. The third step is to dissect the posterior Gerota’s fascia of kidney lower pole from the psoas muscle. Renal pedicle is exposed after anterior retraction of kidney with this surgical plane. Fourth step is to dissect the remained posterior part of the upper pole from the psoas muscle. As whole kidney could be retracted, kidney could be easily dissected from adrenal gland. Last step is ligate and divide the renal pedicle with GIA and the ureter with gonadal vein with another GIA. Whole kidney could be crushed with surgical scissor and extracted
The total operation time was 65 minutes. In our constitution, after the application of this surgical principle, the intra-corporeal time the mean total operation time was decreased from 263.2±52.3 minutes of 12 cases to 197±32.4 minutes of 23 cases. No conversion to other surgical methods or no complication severe than Clavian classification II was reported.
Our step-by-step technique was feasible and demonstrated efficacy to overcome technical difficulties of LESS simple nephrectomy in terms of operation time and complication.