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NOTES left nephrectomy: retroperitoneal transvaginal approach

S Perretta, MD, PhD P Allemann, MD B Dallemagne, MD J Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA
Epublication WebSurg.com, Apr 2008;08(04). URL: http://websurg.com/doi/vd01en2313

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  • 2008-04-09
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This video shows how to perform nephrectomy in the porcine model with a novel transvaginal retroperitoneal NOTES technique. Conceivably, nephrectomy performed through a natural orifice could enhance cosmesis and minimize postoperative recovery. The vagina has been considered a viable route for kidney retrieval following laparoscopic nephrectomies. While NOTES nephrectomy has been previously described, the transvaginal retroperitoneal route has not been explored yet. Under general anesthesia, with the pig supine, the left retroperitoneal space was entered with a double channel endoscope (Storz™) through a posterior colpotomy. A retroperitoneal tunnel was created with blunt dissection with the assistance of insufflation set at 12mm Hg. To prevent penetration of the peritoneal sac, the dissection is carried out in close contact with the psoas muscle up to the Gerota's fascia, which was opened to access the renal hilum. Renal vessels and the ureter were dissected and taken separately between clips. The kidney was dissected free bluntly. Limitations imposed by the porcine anatomy prevented transvaginal specimen retrieval.