Laparoendoscopic Single-Site Nephropexy with Homemade Single Port

Abstract

Introduction: Laparoscopic nephropexy is a safe and effective procedure for symptomatic floating kidney. The posterior retroperitoneoscopic approach is thought to be the most promising method for single-access surgery of the floating kidney. Here, we report our preliminary experiences in laparoendoscopic single-site surgery (LESS) retroperitoneal nephropexy with homemade single port for symptomatic floating kidneys. Materials and Methods: LESS retroperitoneal nephropexy was performed with a homemade single port that was created using an Alexis wound retractor as an access platform through a 2-cm incision beneath the tip of 12th rib.1 This video included a brief presentation of a case of a 65-year-old woman who presented with recurrent urinary tract infection and intermittent right flank soreness when activity. She was a slim woman with a body mass index of 21. The flank soreness was usually exacerbated by an upright position and relived by recumbence. Then, supine and erect intravenous pyelography was performed and it revealed downward displacement of two vertebral bodies of right kidney on erect position. The procedure was completed successfully without conversion. The operative time was 110 min. Results and Conclusions: Between May 2009 and July 2010, we had performed LESS nephropexy for four consecutive patients with symptomatic floating kidneys (bilateral in 1 and right in 3). The mean patient age was 44.6±17.7 years and mean body mass index was 21.4 kg/m2. The mean operative time was 121.0±29.7 min. Mean estimated blood loss was minimal, and mean hospital stay was 3.3±0.5 days. Conversion to an open or conventional retroperitoneoscopic approach was not necessary in all cases. There was no major complication. Follow-up intravenous pyelography study 3 months after procedure revealed that the treated kidneys were in the desired position and axis with a standing descend less than one vertebral body in all patients. In conclusion, LESS retroperitoneal nephropexy with homemade single port is a safe and feasible procedure for symptomatic floating kidneys. Further prospective and long-term studies are warranted to provide more solid evidence with regard to perioperative benefits of LESS nephropexy. All authors have declared no conflicts of interest. Runtime of video: 7 mins 1 sec Shih-Dong Chung and Victor Chia-Hsiang Lin contributed equally to this work.