Laboratory and Clinical Development of Single Keyhole Umbilical Nephrectomy

Jay D. Raman, Karim Bensalah, Aditya Bagrodia, Joshua M. Stern, Jeffrey A Cadeddu

Research output: Contribution to journalArticle

261 Citations (Scopus)

Abstract

Objective: To describe our initial experience with single keyhole nephrectomy in a porcine model and in human subjects. Methods: Eight nonsurvival laparoscopic nephrectomies were performed in 4 female farm pigs. In 3 renal units, the laparoscopic nephrectomy was performed via a novel single 25-mm trocar, while the remaining 5 nephrectomies were performed using one 10-mm and two 5-mm adjacent trocars. Articulating laparoscopic graspers, conventional endoshears, clips, and a stapler were used for dissection. Three human subjects underwent a single keyhole umbilical laparoscopic nephrectomy with similar instrumentation. Indications for nephrectomy included chronic infection in a nonfunctioning kidney in 2 patients, and a 4.5-cm enhancing renal mass in the other patient. Results: Single keyhole nephrectomy was successfully completed in all 8 porcine renal units and in all 3 human subjects. The mean operative time for the porcine nephrectomies was 49 minutes (range, 20 to 85), with a mean blood loss of 20 mL (range, 5 to 100). Incision size ranged from 3 to 5 cm. The mean operative time for the human nephrectomy cases was 133 minutes (range, 90 to 160). Estimated blood loss was 30 mL, and the kidneys were extracted through a solitary 2 to 4.5 cm periumbilical incision. There were no perioperative complications, and all 3 patients were discharged on hospital day 2. Conclusions: Keyhole umbilical nephrectomy utilizing articulating laparoscopic instrumentation to facilitate triangulation is feasible. We demonstrate safe and successful completion both in a porcine model and in the 3 human patients. Future studies will need to assess the benefits of single-access surgery in comparison to conventional laparoscopy.

Original languageEnglish (US)
Pages (from-to)1039-1042
Number of pages4
JournalUrology
Volume70
Issue number6
DOIs
StatePublished - Dec 2007

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Umbilicus
Nephrectomy
Swine
Kidney
Surgical Instruments
Operative Time
Laparoscopy
Dissection

ASJC Scopus subject areas

  • Urology

Cite this

Laboratory and Clinical Development of Single Keyhole Umbilical Nephrectomy. / Raman, Jay D.; Bensalah, Karim; Bagrodia, Aditya; Stern, Joshua M.; Cadeddu, Jeffrey A.

In: Urology, Vol. 70, No. 6, 12.2007, p. 1039-1042.

Research output: Contribution to journalArticle

Raman, Jay D. ; Bensalah, Karim ; Bagrodia, Aditya ; Stern, Joshua M. ; Cadeddu, Jeffrey A. / Laboratory and Clinical Development of Single Keyhole Umbilical Nephrectomy. In: Urology. 2007 ; Vol. 70, No. 6. pp. 1039-1042.
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