The single instrument port laparoscopic (SIMPL) nephrectomy

Abstract 

Aims

To describe a novel modification of the posterior prone retroperitoneoscopic nephrectomy/nephroureterectomy which allows the entire procedure to be performed through a single instrument port.

Methods

With the patient in a prone position, a retroperitoneal working space is created with the aid of a homemade balloon. A single instrument port is then placed at the tip of the 11th/12th rib under direct vision. Gerota's fascia is incised, the kidney is reflected anteriorly, and the hilar vessels are identified and divided. The ureter is mobilized as far distally as possible before division. The specimen is removed directly via the camera port or in an endobag.

Results

We have employed this technique in 26 children with a high success rate. The median operating time was 58 (range 45–90) min. Blood loss was minimal in all cases and there were no complications. There have been no conversions and the cosmetic outcome has been excellent. Most of the children (24 of 26) were discharged home the day after surgery.

Conclusions

The single instrument port laparoscopic (SIMPL) nephrectomy is a feasible and safe technique for the experienced paediatric laparoscopic urologist.

Keywords: Laparoscopy, Nephrectomy, Paediatric