The single instrument port laparoscopic (SIMPL) nephrectomy

Abstract

Purpose Since the introduction of minimally invasive surgery there have been many modifications of approach and refinement of technique. We describe a novel modification of the Posterior Prone Retroperitoneoscopic (PPR) nephrectomy, which allows the entire operation to be performed through a single instrument port. Material and methods With the patient in a prone position a retroperitoneal working space is created, with the aid of homemade balloon. A single instrument port is then placed at the tip of the 11th/12th rib under direct vision. The laparoscope and instrument are both held by the operating surgeon. The Gerota's fasciae incised, the kidney is reflected anteriorly. The vessels are identified and divided. The remaining dissection is completed with a harmonic scalpel and the specimen is placed in an endobag and removed. Utmost care must be taken to avoid even minor oozing in order to keep the field clear. Results We have employed this technique successfully in 54 children. The median age at surgery was 3 years (range 3months -10 years). The procedure was successfully completed in 54 children. The median operating time was 52 minutes (range 35-96 minutes).The blood loss was minimal and there were no open conversions. Most of the children were discharged the day after surgery, and the cosmetic outcome (51 of 54) has been excellent in all cases. Conclusions In comparisons with the traditional approach, the SIMPL approach avoids instrument crowding and maximizes the restricted retroperitoneal working space. Avoiding the second port essentially reduces the overall cost of the disposables'. The technique is quickly mastered by both experienced laparoscopic surgeon and trainee surgeon. SIMPL nephrectomy is feasible and safe. Since the introduction of minimally invasive surgery there have been many modifications of approach and refinement of technique. We describe a novel modification of the Posterior Prone Retroperitoneoscopic (PPR) nephrectomy, which allows the entire operation to be performed through a single instrument port. With the patient in a prone position a retroperitoneal working space is created, with the aid of homemade balloon. A single instrument port is then placed at the tip of the 11th/12th rib under direct vision. The laparoscope and instrument are both held by the operating surgeon. The Gerota's fasciae incised, the kidney is reflected anteriorly. The vessels are identified and divided. The remaining dissection is completed with a harmonic scalpel and the specimen is placed in an endobag and removed. Utmost care must be taken to avoid even minor oozing in order to keep the field clear. We have employed this technique successfully in 54 children. The median age at surgery was 3 years (range 3months -10 years). The procedure was successfully completed in 54 children. The median operating time was 52 minutes (range 35-96 minutes).The blood loss was minimal and there were no open conversions. Most of the children were discharged the day after surgery, and the cosmetic outcome (51 of 54) has been excellent in all cases. In comparisons with the traditional approach, the SIMPL approach avoids instrument crowding and maximizes the restricted retroperitoneal working space. Avoiding the second port essentially reduces the overall cost of the disposables'. The technique is quickly mastered by both experienced laparoscopic surgeon and trainee surgeon. SIMPL nephrectomy is feasible and safe.