You have accessJournal of UrologyLaparoscopic Partial Nx and Single Port Surgery1 Apr 2010V958 HYBRID NOTES TRANSVAGINAL NEPHRECTOMY Rene Sotelo, Robert De Andrade, Golena Fernandez, Roberto Garza, Daniel Ramirez, Camilo Giedelman, Eugenio Di Grazia, Oswaldo Carmona, David Canes, Monish Aron, Mihir Desai, and Inderbir Gill Rene SoteloRene Sotelo Caracas, Venezuela More articles by this author , Robert De AndradeRobert De Andrade Caracas, Venezuela More articles by this author , Golena FernandezGolena Fernandez Caracas, Venezuela More articles by this author , Roberto GarzaRoberto Garza Caracas, Venezuela More articles by this author , Daniel RamirezDaniel Ramirez Caracas, Venezuela More articles by this author , Camilo GiedelmanCamilo Giedelman Caracas, Venezuela More articles by this author , Eugenio Di GraziaEugenio Di Grazia Caracas, Venezuela More articles by this author , Oswaldo CarmonaOswaldo Carmona Caracas, Venezuela More articles by this author , David CanesDavid Canes Burlington, MA More articles by this author , Monish AronMonish Aron Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , and Inderbir GillInderbir Gill Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1863AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pure NOTES (Natural Orifice Translumenal Endoscopic Surgey) transvaginal radical nephrectomy has been performed only in cadavers and animal models because of technical difficulties in humans. Few cases of hybrid NOTES transvaginal radical nephrectomy (using 2 extraumbilical abdominal ports) have been reported with success in humans. In this video we present a hybrid transvaginal NOTES radical nephrectomy using transvaginal trocars (multi-channel in one case, single 12mm trocar in the others), and a transumbilical multi-channel single port. METHODS Transvaginal radical nephrectomy was performed in three patients with left sided kidney tumors in two and one right side. Triports (Advanced Surgical Concepts, Dublin, Ireland) were inserted in the umbilicus, and the vagina in case one. For thesecond and third case, presence of the uterus allowed space for a transvaginal conventional 10mm bariatric trocar and one Triport (Advanced Surgical Concepts, Dublin, Ireland) Visualization was performed interchangeably from umbilical and transvaginal views using the 5 mm flexible-tip endoeye camera (Olympus, Tokyo, Japan). Dissection, using straight or bent instruments, was performed predominantly transvaginally with the exception of hilar dissection and control. Specimen extraction was accomplished by the vagina access by an extended colpotomy. RESULTS Mean operative time was 155 minutes (range 220 to 95 minutes) and mean estimated blood loss was 250 cc. The patients had an uneventful postoperative course and were discharged 2 days after the procedure in case 1 and 2, and the case 3 was discharged 6 days. The first case was complicated by abscess in the renal fossa requiring percutaneous drainage. The second case had no complications. In the third case conversion to standard laparoscopy was necessary because of obesity and inflammation around the kidney. Pathology revealed clear cell carcinoma of 6.5 cm in with no local infiltration in one patient, chromophobe in the second case, and kidney atrophy in the third case. CONCLUSIONS Pure NOTES transvaginal nephrectomy is still technically demanding because of the absence of adequate instruments and surgical expertise in performing a safe and effective dissection. However our hybrid transvaginal technique assisted by a umbilical single port is an appealing alternative to further reduce morbidity, obtain a virtually scarless outcome, and safely develop increasingly complex transvaginal dissection techniques. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e372 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rene Sotelo Caracas, Venezuela More articles by this author Robert De Andrade Caracas, Venezuela More articles by this author Golena Fernandez Caracas, Venezuela More articles by this author Roberto Garza Caracas, Venezuela More articles by this author Daniel Ramirez Caracas, Venezuela More articles by this author Camilo Giedelman Caracas, Venezuela More articles by this author Eugenio Di Grazia Caracas, Venezuela More articles by this author Oswaldo Carmona Caracas, Venezuela More articles by this author David Canes Burlington, MA More articles by this author Monish Aron Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...