Transvaginal nephrectomy with a multichannel laparoscopic port

A cadaver study

Monish Aron, Andre K. Berger, Robert J. Stein, Kazumi Kamoi, Ricardo Brandina, David Canes, Rene Sotelo, Mihir M. Desai, Inderbir S. Gill

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective To determine whether a novel port (QuadPort, Advanced Surgical Concepts, Wicklow, Ireland) can facilitate transvaginal nephrectomy (TN), a natural orifice transluminal surgery (NOTES) procedure, using standard and articulating laparoscopic instruments. MATERIALS AND METHODS Four fresh female cadavers were used in this feasibility study with a plan to perform two right-sided and two left-sided TN. Exclusion criteria were a history of nephrectomy and a height of >1.82 m. The cadaver was placed in the lithotomy position with the target side up 30-45°. A three-channel R-port (Advanced Surgical Concepts) was placed in the umbilicus to monitor the transvaginal procedure. The four-channel QuadPort was placed through the posterior fornix into the peritoneal cavity. Regular laparoscopic instruments were used transvaginally to mobilize the colon, dissect the ureter, identify and divide the renal artery between clips, and divide the renal vein with a laparoscopic stapler. Remaining attachments of the kidney were divided and the specimen entrapped in a plastic bag before transvaginal extraction. Results Three (two right- and one left-sided) TNs were performed successfully; one left-sided TN was aborted in the last cadaver due to dense pelvic adhesions from previous pelvic surgery. In the first two cadavers we required assistance from the umbilical port only to divide the attachments between the upper pole of the kidney and the diaphragm supero-posteriorly. In the third case we were able to perform this dissection completely transvaginally using a flexible gastroscope. ConclusionS A completely NOTES-based TN in humans is challenging. Robust laparoscopic instruments have the requisite tensile strength when deployed through a large calibre, secure, multichannel transvaginal port. Extra-long laparoscopic instruments are helpful. The cephalad aspect of the hilum and the upper pole attachments are difficult areas. Novel and robust flexible instruments still need to be developed.

Original languageEnglish (US)
Pages (from-to)1537-1541
Number of pages5
JournalBJU International
Volume103
Issue number11
DOIs
StatePublished - Jun 2009
Externally publishedYes

Fingerprint

Nephrectomy
Cadaver
Umbilicus
Gastroscopes
Kidney
Renal Veins
Tensile Strength
Peritoneal Cavity
Feasibility Studies
Renal Artery
Ureter
Diaphragm
Ireland
Surgical Instruments
Plastics
Dissection
Colon

Keywords

  • Laparoscopy
  • Nephrectomy
  • NOTES
  • Single-port
  • Transvaginal

ASJC Scopus subject areas

  • Urology

Cite this

Aron, M., Berger, A. K., Stein, R. J., Kamoi, K., Brandina, R., Canes, D., ... Gill, I. S. (2009). Transvaginal nephrectomy with a multichannel laparoscopic port: A cadaver study. BJU International, 103(11), 1537-1541. https://doi.org/10.1111/j.1464-410X.2009.08612.x

Transvaginal nephrectomy with a multichannel laparoscopic port : A cadaver study. / Aron, Monish; Berger, Andre K.; Stein, Robert J.; Kamoi, Kazumi; Brandina, Ricardo; Canes, David; Sotelo, Rene; Desai, Mihir M.; Gill, Inderbir S.

In: BJU International, Vol. 103, No. 11, 06.2009, p. 1537-1541.

Research output: Contribution to journalArticle

Aron, M, Berger, AK, Stein, RJ, Kamoi, K, Brandina, R, Canes, D, Sotelo, R, Desai, MM & Gill, IS 2009, 'Transvaginal nephrectomy with a multichannel laparoscopic port: A cadaver study', BJU International, vol. 103, no. 11, pp. 1537-1541. https://doi.org/10.1111/j.1464-410X.2009.08612.x
Aron M, Berger AK, Stein RJ, Kamoi K, Brandina R, Canes D et al. Transvaginal nephrectomy with a multichannel laparoscopic port: A cadaver study. BJU International. 2009 Jun;103(11):1537-1541. https://doi.org/10.1111/j.1464-410X.2009.08612.x
Aron, Monish ; Berger, Andre K. ; Stein, Robert J. ; Kamoi, Kazumi ; Brandina, Ricardo ; Canes, David ; Sotelo, Rene ; Desai, Mihir M. ; Gill, Inderbir S. / Transvaginal nephrectomy with a multichannel laparoscopic port : A cadaver study. In: BJU International. 2009 ; Vol. 103, No. 11. pp. 1537-1541.
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AU - Brandina, Ricardo

AU - Canes, David

AU - Sotelo, Rene

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