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VR-30
(VS)
SINGLE INCISION PRONE RETRO-PERITONEOSCOPIC PAEDIATRIC
NEPHRECTOMY
Neil FEATHERSTONE
1
, Gunter DE WIN
2
, Shabnam UNDRE
1
and Abraham CHERIAN
1
1) Great Ormond Street Hospital for Sick Children, Department of Urology, London, UNITED KINGDOM - 2) Antwerp
University Hospital, Urology Department, Antwerp, BELGIUM
PURPOSE
The first paediatric laparoendoscopic single site (LESS) nephrectomy was reported in 2009. We have previously
published our early experience (two patients) of single incision nephrectomy via the retroperitoneal prone route using an
advanced access platform (GelPOINT Mini – Advanced Medical, CA, USA). Here, we review our single centre series to
date and also present a detailed video demonstrating the technique.
MATERIAL AND METHODS
In the prone position, a single transverse incision was made at the midpoint on a line along the lateral border of erector
spinae bounded by the lower border of the 12th rib and iliac crest. Posterior abdominal muscles were split and the deep
lumbodorsal fascia incised. The Alexis retractor was positioned and the Gel-Seal cap with low-profile sleeves locked in
place. Hilar vessels were divided by endoclip application or harmonic scalpel. The kidney was retrieved directly or via an
endobag. The Alexis retractor was removed and wound closed with absorbable sutures.
RESULTS
Between July 2013 and March 2015, we have used this approach to perform ten nephrectomies in 9 patients (4 male
and 5 female). Nephrectomies were performed for multicystic dysplastic kidneys (n=4), focal segmental
glomerulosclerosis (n=2), obstructive nephropathy (n=3) and dysplasia (n=1). Median age at nephrectomy was 10.9
years (range 2.7 – 15.9 years). Median patient weight was 34.9 Kg (15.4 – 78Kg). Median kidney length was 7.5 cm
(range 3.7 – 11.5 cm). No complications occurred and none converted to open procedure.
CONCLUSIONS
Single incision retroperitoneal nephrectomy is feasible, safe and provides excellent cosmesis.