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10.5005/jp-journals-10007-1102 WJOLS
REVIEW ARTICLE Single Access Laparoscopic Nephrectomy
Single Access Laparoscopic Nephrectomy

Issac Syiem
Surgeon, Department of General and Laparoscopy Surgery, The Nook, Nongrim Hills, Shillong, India

Abstract
Laparoscopic nephrectomy has assumed a central role in the management of kidney diseases. Laparoscopy, inspite of its less
morbidity than open surgery, still requires several incisions. These incisions carry risks of bleeding, ventral hernia, damage to internal
organs and decreased cosmesis.
An alternative to laparoscopy is the single access or keyhole surgery. This keyhole surgery utilizes the new laparoscopy access port
(R-Port), single port access (SPA) procedure, one port umbilical surgery (OPUS), the " belly button" entry, natural orifice transluminal
endoscopic surgery, and the magnetic anchoring and guidance system (MAGS) technology.
Keywords: SILS, SILS nephrectomy, Laparoscopic nephrectomy.

INTRODUCTION deflectable tip video laparoscope (Olympus, Orangeburg,
NY, USA).
Open nephrectomy performed through the muscle splitting
flank incision was the gold standard therapy for many kidney CLINICAL EXPERIENCE
diseases. This was replaced by the less morbid procedure,
the laparoscopic nephrectomy. Since the first laparoscopic Raman and colleagues reported their experience with
nephrectomy by Clayman and colleagues in 1991, minimally keyhole nephrectomy in a porcine model and human
invasive urologic surgery has gained significant momentum. subjects. In their series, keyhole nephrectomy was
In an effort to reduce the sequelae of laparoscopic completed successfully in 8 porcine renal units and in all
nephrectomies, single access or keyhole surgeries have three human subjects. The mean operative time for the
developed. porcine nephrectomies was 49 minutes with a mean blood
loss of 20 cc. Incision size ranged from 3 to 5 cm. The
mean operative time for the human nephrectomy cases
ARTICULATING LAPAROSCOPIC
INSTRUMENTATION was 133 minutes, estimated blood was 30 cc and the
kidneys were extracted through a solitary 2 to 4.5 cm
This involves using articulating instrumentation via a single periumbilical incision. There were no perioperative
large caliber trocar or small/adjacent trocars. Advances in complications and all three patients were discharged from
technology have led to the development of new access port hospital on day 2.
(R-Port, Advanced Surgical Concepts, Wicklow, Ireland The attractiveness of keyhole umbilical nephrectomy
and Uni-X single port, P navel systems, Cleveland, OH, is multifaceted. First, it improves cosmesis by allowing a
USA) capable of allowing multiple instruments to be inserted single umbilical incision. Second, it is within a surgeon's
through different cannulas of a single port. Alternatively, comfort range since specimen extraction occurs via the
adjacent 5 mm trocars can be utilized with skin trocars abdomen. Third, the learning curve appears to be much
connected at the time of specimen extraction. shorter than for NOTES. Finally, keyhole umbilical surgery
Currently, articulating laparoscopic graspers, endoshears provides a "familiar" anatomical view of the kidney.
and laparoscopic needle drivers are commercially available
for clinical use. NOTES
In conjunction with articulating instrumentation, the Natural orifice transluminal endoscopic surgery approaches
development of novel intra-abdominal retractor will further abdominal surgey through natural orifices (mouth, vagina,
facilitate evolution of laparoscopic procedures. One such and rectum). Animal models have been used to demonstrate
device is the pardon endoscopic exposing retractor (PEER). the potential application of NOTES, including transgastric
Another important component is 45 degrees 5 mm rigid and transvesical peritoneoscopy, transvaginal tubal ligation,
laparoscope with an end light source (karl storz) or a 5 mm hysterectomy, and cholecystectomy.

World Journal of Laparoscopic Surgery, September-December 2010;3(3):151-152 151