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Scarless Nephrectomy By Transgastric And Transvesical Combined Approach

March 21, 2017

UroToday - Dr. Lima from Porto, Portugal presented the novel concept of "natural orifices translumenal endoscopic surgery" (NOTES) as applied to nephrectomy in an experimental model. Their team assessed the feasibility of a combined transgastric and transvesical approach for performing nephrectomy in a porcine model.

In a non-survival study, a transgastric and transvesical combined approach was applied in 6 female pigs. Under ureteroscopic control, they placed a transvesical 5-mm over tube into the peritoneal cavity, and a flexible gastroscope was passed orally into the peritoneal cavity by a gastrotomy. Four right and two left nephrectomies were performed using instruments introduced by both devices. The pigs suffered no complications during creation of transvesical and transgastric access. In all animals, they visualized both kidneys, and the renal vessels and ureter were identified and ligated separately with ultrasonic scissors, which were introduced through the transvesical port. In two early cases, mild bleeding occurred after ultrasonic ligation. Complete renal release and mobilization to the stomach was achieved in all animals. During the discussion, it became apparent that none of the "resected" kidneys were removed from the porcine bodies, and this would require some sort of incision.

Presented by: E. Lima, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday Contributing Editor, Christopher P. Evans, MD

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