V11-12: Laparaoendoscopic single-site surgery (LESS) nephrectomy: Step by step technique

Video

Introductions and Objectives
Laparaoendoscopic single-site surgery (LESS) has been recently reported as an alternative to conventional laparoscopy aiming to decrease the patients᾽ morbidity and to improve cosmetic outcome. However, LESS has its own technical difficulties due to loss of triangulation. We present a video that shows the step by step technique of LESS right nephrectomy for non-functioning kidney with advanced hydronephrosis.

Methods
In this video we present 36 years old female that was complaining of right flank dull aching pain, Ultrasound showed right advanced hydronephrosis. Computed tomography of the abdomen and pelvis revealed right advanced hydronephrosis where the kidney was occupying the right half of the abdomen and extending down to the pelvis. Renal isotope showed zero function of the right kidney. While the patient in the modified lateral position, about 2-cm skin insision was made in the umbilicus along the midline. Through this incision an access to peritoneal cavity was done. Covidien port was inserted and both articulating and straight instruments as well as 5-mm EndoEye camera were used. Peritoneum was incised along the Toldt line and the colon was reflected medially. The lower pole of the kidney was mobilized and the duodenum was reflected medially. Both the renal artery and vein were dissected and clipped. The kidney was mobilized by combining both sharp and blunt dissection. While dissecting its upper pole, the kidney was partially drained to facilitate its dissection. Homeostasis was checked at the renal bed. The kidney was completely drained and placed in a home made an endobag and removed through the port insertion site without need to increase the original umbilical incision.

Results
Operative time was 95 minutes. There were no intraoperative or postoperative complications. Blood loss was less than 50 c.c. No extra-port was added. No conversion to conventional laparoscopy or open surgery was done. The patient was discharged from the hospital after 1 day. Visual analog pain scale at discharge was 1.5. Follow-up of the patient showed invisible umbilical scar and high satisfaction.

Conclusions
In experienced hands, LESS nephrectomy is a safe procedure with significant low morbidity and high patient's cosmetic satisfaction.

Funding: none