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Bashir Yunusa et al 10.5005/jp-journals-10033-1221
OriginaL articLe

Is There an Ideal Port Position for Laparoscopic

Urological Procedures?

3
1 Bashir Yunusa, RK Mishra, JS Chowhan
2
ABSTRACT used as a camera port. Another 12 mm laparoscopic port is
Background: Reports have suggested increased use of placed between umbilical port and anterior superior iliac
laparoscopy in the treatment of urological diseases and equally spine (spinoumbilical port) and a 5 mm port is placed in
wrong port positions as the commonest cause of struggling during line with the camera port at about 3 cm below the costal
surgeries and increased in complications and operative time.
Aim: We aimed to find out the ideal positions for laparoscopic margin and 3 cm lateral to the midline. The fourth usually
ports to be placed during urological procedures. for retraction if needed, is a 5 mm port placed 4 cm below
1­6
Methods: We performed different laparoscopic tasks in both the the costal margin in anterior axillary line. Both kidneys
upper and lower urinary tract regions, at different ports position have similar approach on either side.
making different manipulation angles and operative time recorded.
The procedures were performed on both dry and wet laboratory Another approach is to place the laparoscopic port on the
and on human during laparoscopic donor nephrectomies. midclavicular line just at or above the upper border of the
Results: The average operative time of those ports whose umbilicus. A working port usually 10/12 mm is positioned
position approximate to manipulation angle of 60º was shorter
and more comfortable to the surgeons. a fingerbreadth below the costal margin on the anterior
Conclusion: There is no ideal positions for port placement axillary line. A second working port, is placed on the ante­
in urological procedures based on anatomical landmarks, but rior axillary line just above the superior iliac crest. An
rather any position that approximate its manipulation angle to additional working port may be placed on the midaxillary
as close to 60º as possible.
Keywords: Port positioning, Manipulation angles, Laparoscopic line midway between the costal margin and the superior iliac
urological. crest to provide access for a retracting instrument and to
How to cite this article: Yunusa B, Mishra RK, Chowhan JS. Is mobilize the kidney laterally. For the extremely thin patient
There an Ideal Port Position for Laparoscopic Urological Proce- the port sites are all moved medially with the laparoscope
dures? World J Lap Surg 2014;7(2):74-87.
Source of support: Nil at the umbilicus, the working ports on the midclavicular
8
Conflict of interest: None line and an additional port on the anterior axillary line.
One other approach for the left kidney is to place the
InTRodUCTIon camera port at the paraumblical space at the lateral border
of the rectus muscle at the level of the umbilicus while the
Laparoscopic nephrectomy and Port Positioning patient is placed in the right lumbotomy position; through

There are various approaches to nephrectomy and the placement the open introduction technique according to Hasson. One
of ports depends on the approach and the side, and whether or additional 10 mm and one 5 mm trocar are then inserted
not a single site laparoendoscopic approach is intended. under laparoscopic vision in the epigastric and midclavi­
cular positions. 9
Transperitoneal Approach The left kidney can also be approached with the camera
In this approach, usually a 12 mm port is placed at umbi­ port placed just to the left of the umbilicus. The left hand
licus by open Hasson technique, which is often primarily 12 mm port placed along the lateral border of the rectus
abdominis muscle lateral to the umbilicus. The right hand
port placed on the lateral border of the rectus near the dome
2
3
1 Senior Registrar, Professor, Consultant of the bladder. A fourth port to be placed laterally to retract
1 Department of Surgery, Division of Urology, Aminu Kano Teaching the sigmoid colon medially. 10
Hospital, Kano, Nigeria
The Retroperitoneal Approach to the Kidneys
2 Minimal Access Surgery, World Laparoscopy Hospital, Gurgaon
Haryana, India In the retroperitoneal laparoscopic approach, incision is
3 Department of Laparoscopic Surgery, World Laparoscopy made at tip of 12th rib and then blunt dissection or balloon
Hospital, Gurgaon, Haryana, India used to create space and the working port is placed between

Corresponding Author: Bashir Yunusa, Senior Registrar the midaxillary line and the anterior axillary line (5 cm above
Department of Surgery, Division of Urology, Aminu Kano the iliac crest). A 5 mm port is then inserted at the junction
Teaching Hospital, Kano, Nigeria, e-mail: bashrano@gmail.com 11
of the 12th rib and paraspinal muscles (renal angle).
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