Introduction
Advantages of transperitoneal and retroperitoneal laparoscopic nephrectomy in comparison to open nephrectomy are well established. The vagina is a viable route for kidney retrieval following laparoscopic nephrectomies. Conceivably, nephrectomy performed through a natural orifice could enhance cosmesis and patients recovery.
Aim: to explore trans-vaginal retroperitoneal NOTES total and partial nephrectomy in the porcine model.
Materials and methods
Total and partial right nephrectomies were performed in 2 female pigs. Under general anaesthesia, with the pig supine, the retroperitoneal space was entered with a double channel endoscope(Storz™) through a posterior colpotomy performed with the needle-knife™. A retroperitoneal tunnel is created with blunt dissection up to the renal vessels and the ureter which are dissected and taken separately between endoscopic clips. The anterior and medial aspect of the specimen is now mobilized from the underside of the peritoneal envelope.
For partial nephrectomy the access to the kidney is performed using the same technique. The renal artery and vein are circumferentially dissected up to the renal parenchyma with separation of the 2 main arterial branches, which are clamped individually to assess the blood supply of the inferior pole. At this point the inferior branch is clip occluded and divided with endoscopic scissors leaving two endoclips on the remaining stump. An inferior partial nephrectomy is then carried out successfully with a bloodless field of resection.
Results
Both total and partial nephrectomies were successfully accomplished by a totally NOTES approach with an operative time of 60 and 50 minutes respectively. No injury occurred to any of the retroperitoneal structures.
Conclusions
Transvaginal retroperitoneal NOTES total and partial nephrectomy are feasible in the porcine model. Retroperitoneal transvaginal dissection, preserving the peritoneum, could represent an additional step to further decrease morbidity. Avoiding bowel handling, it may minimize postoperative ileus and expedite patient recovery. This approach might be especially valuable in patients with multiple previous abdominal operations and in cases in which a trans-vaginal extraction is already planned
Session: Video Channel
Program Number: V055