Lepro endoscopic single site surgery offers an evolution in minimally invasive surgery by minimizing surgical scars and thereby potentially reducing postoperative pain and possibly shortening recovery time. This video provides an illustration of the equipment and steps required to perform a single site labro endoscopic donor nephrectomy, as well as report on our institution's initial experience with this technique. Single site nephrectomy requires a specific set of equipment.
These include A bariatric 10 millimeter lens, a right angle attachment for the light cord, a gel point seal device, And a corresponding Alexis wound Retractor two five millimeter trocars, one 15 millimeter trocar, one 10 to 12 millimeter trocar. Single port nephrectomy utilizes a five centimeter umbilical incision following dissection of the subcutaneous tissue. The fascia is open vertically via a similar five centimeter incision to gain peritoneal access.
Accurate preparation of the incision requires pulling the skin taut in a vertical direction to flatten the bolus. This ensures the appropriate incision size, which aids in creating a seal for pneumoperitoneum, as well as optimizes the cosmetic appearance of the wound. The next step involves insertion of the Alexis wound retractor attachment of the gel point seal and initiation of the pneumoperitoneum.
The green internal ring of the Alexis wound retractor is placed into the peritoneal cavity. A gentle sweep of the internal ring ensures that there is no intraabdominal tissue caught within the retractor. An inward folding of the ring approximates the external retractor to the skin and ensures a good seal with the abdominal wall.
Trocars are placed through the gel point seal with the insulation port pointed upwards and the applied medical triangle providing reference points for initial trocar positioning. The two five millimeter ports are placed at the lateral corners of the triangle. The 15 millimeter port is placed at the bottom of the triangle.
This initial triangulation Serves to provide adequate working space for all ports. The gel point seal is clasped through the external ring and pneumoperitoneum is initiated. This image illustrates our initial port configuration.
The following segments of the video demonstrate the standard steps of a laparoscopic donor nephrectomy performed through the single port system. Utilizing standard laparoscopic equipment, peritoneal incision begins at the white line of tot The colon is Mobilized medially, and this incision is carried cephalad towards the splenic flexor and spinal Read ligament. The narrow channel Of the single port system can limit instrument movement.
Triangulation of the trocars minimizes this challenge. However, intraoperative adjustment of trocars may be required to optimize dissection. Dissection of the plane between the spleen and the kidney, further mobilizes the colon and spleen medially.
This aids in exposure Of the renal hilum, Elevation of retroperitoneal fat cephalad and anterior to the common iliac artery aids in the identification of the ureter. Following a gonadal vein towards the renal hilum provides a path for the safe identification and dissection of the renal vein. The left adrenal vein is identified at its insertion point into the left renal vein.
The left adrenal vein is then doubly clipped and ligated. Lateral retraction of the kidney facilitates the identification and isolation of the left renal artery With the hilum vessels carefully identified and isolated dissection proceeds to the upper pole with the separation of the adrenal gland from tis fascia. Release of the lateral attachments completes the kidney mobilization.
Organ extraction begins with a staple ligation of the completely ureter. This is performed distally near its intersection with the common iliac vessels. A five millimeter port can be exchanged for a 12 meter port and this allows for the use of an endo, TA and endo GIA staplers lateral elevation of the kidney again provides the traction that allows for the division of the renal artery.
Ligation of the renal vein is achieved with an endo GIA stapler Organ Extraction completes with a placement of the kidney and ureter in an endo catch bag. The gels seal cap and Alexis wound retractor are then removed and the organ is removed through the single incision. Standard wound closure hides the incision within the umbilicus.
In conclusion, our demonstrated approach provides us with encouraging early perspective data and it supports additional work to validate this technique.
