Technical and equipment challenges for laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery

Single Port Donor Nephrectomy Via Modified Pfannenstiel Incision: Initial Preclinical Experience in A Cadaveric Model and Description of Technique

OBJECTIVE

To describe the surgical technique for the single port (SP) transperitoneal donor nephrectomy through a modified Pfannenstiel incision using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA, USA) on a cadaver.

PATIENTS & METHODS

In a male cadaver, the SP surgical system was used to perform transperitoneal donor nephrectomy. A 3 cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA, USA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25 mm multichannel port and a 12 mm assistant port were introduced. The surgical steps for donor nephrectomy were performed in the following order. 1) Mobilization of the colon, 2) Identification of psoas muscle, ureter, and the gonadal vein, 3) hilum dissection, 4) perirenal dissection, 5) stapling the renal artery and renal vein, 6) removal of the kidney through the enlarged incision.

RESULTS

Transperitoneal SP donor nephrectomy was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm.

CONCLUSION

We demonstrated the feasibility of single-port transperitoneal donor nephrectomy via modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.

Future robotic platforms in urologic surgery: recent developments

PURPOSE OF REVIEW

To review recent developments at Vanderbilt University of new robotic technologies and platforms designed for minimally invasive urologic surgery and their design rationale and potential roles in advancing current urologic surgical practice.

RECENT FINDINGS

Emerging robotic platforms are being developed to improve performance of a wider variety of urologic interventions beyond the standard minimally invasive robotic urologic surgeries conducted currently with the da Vinci platform. These newer platforms are designed to incorporate significant advantages of robotics to improve the safety and outcomes of transurethral bladder surgery and surveillance, further decrease the invasiveness of interventions by advancing LESS surgery, and to allow for previously impossible needle access and ablation delivery.

SUMMARY

Three new robotic surgical technologies that have been developed at Vanderbilt University are reviewed, including a robotic transurethral system to enhance bladder surveillance and transurethral bladder tumor, a purpose-specific robotic system for LESS, and a needle-sized robot that can be used as either a steerable needle or small surgeon-controlled micro-laparoscopic manipulator.

Pediatric single port transumbilical nephrectomy and nephroureterectomy

Objective

To present seven cases of single incision laparoscopic nephrectomy and nephroureterectomy in children as a recent videoscopic innovation.

Patients and methods

Seven children with nonfunctioning kidneys, three with multicystic dysplastic kidneys, two with end-stage renal nephropathy due to vesicoureteral reflux, and two with giant hydronephrosis were qualified to nephrectomy or nephroureterectomy. The surgery was performed transperitoneally using single incision access laparoscopy. The operative time was in the range of 50-90 min.

Results

There were no intraoperative or postoperative complications. The patients were discharged on the third postoperative day. The incision scars were hidden inside the umbilicus.

Conclusions

Nephrectomy or nephroureterectomy using a single transumbilical port in children is a feasible and efficacious technique. The advantages are shortened convalescence, excellent cosmetic results, and reduction of potential wounds complications. However, clear indication of single site laparoscopic procedures in children remains to be clarified.