Korean J Urol.  2011 Jan;52(1):44-48.

Feasibility of Laparoendoscopic Single-Site Partial Nephrectomy in a Porcine Model

• Koo DH
• Park YH
• Jeong CW
• Jeong H
• Kim HH
• Lee SB

Abstract

PURPOSE
We performed laparoendoscopic single-site (LESS) partial nephrectomy in a porcine model with the objectives of overcoming the technical challenges of this surgery and exploring its feasibility.
MATERIALS AND METHODS
Six partial nephrectomies were performed on a pig aged 5 months, three cases on each kidney, by four surgeons: two urologists with much experience in laparoscopic surgery (E1, E2) and two less-experienced urologists (B1, B2). While under general anesthesia, the swine was placed in a lateral flank position. Umbilical placement of an Octoport was done with a 2.5 cm incision. After dissection of the renal hilum and Gerota's fascia, a bulldog clamp was applied on the renal artery and parenchymal resection was done. Renorrhaphy was then performed with interrupted sutures with the use of a sliding knot technique.
RESULTS
All six partial nephrectomies were performed successfully after repair of the vascular and collecting system at the resection margin and renorrhaphy without the need to introduce any additional ports. There were no noticeable intra- or postoperative complications. The mean warm ischemic time was 42 minutes (range, 30-60 minutes). The shortest warm ischemic time, 30 minutes, was achieved by using the early unclamping technique during renorrhaphy. The longest warm ischemic time was 60 minutes. The average number of renorrhaphy stitches was 3.2 (range, 2-5).
CONCLUSIONS
LESS partial nephrectomy was successfully performed in a porcine model but resulted in a longer ischemic time than that of conventional laparoscopic surgeries. Therefore, further laboratory disciplinary efforts are needed to decrease the warm ischemic time and to improve this surgical technique.

Keyword

Kidney neoplasms; Laparoscopy; Nephrectomy

MeSH Terms

Aged
Anesthesia, General
Fascia
Humans
Kidney
Kidney Neoplasms
Laparoscopy
Nephrectomy
Postoperative Complications
Renal Artery
Sutures
Swine
Warm Ischemia

Figure

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  FIG. 1 Porcine model under anesthesia with umbilical Octoport placement.

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  FIG. 2 A typical example of partially resected renal parenchyma.

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  FIG. 3 The resected right (A) and left (B) kidneys demonstrate perfect renal parenchymal sutures.

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