Radially expanding laparoscopic access for renal/adrenal surgery

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Urologic Surgery

Background:

• Access-related complications are a significant challenge in laparoscopic renal and adrenal surgery.
• These complications are more frequent in patients with a history of abdominal surgery due to adhesions.

Purpose of the Study:

• To evaluate a radially expanding access system (Step) and a modified port location to minimize access-related complications.
• To assess the safety and efficacy of this technique in renal and adrenal surgery.

Main Methods:

• A radially expanding trocar system was used for laparoscopic upper tract procedures in 62 patients.
• Initial access was gained subcostally in the midclavicular line, followed by trocar insertion using a fascial dilator.
• Additional ports were placed under direct vision based on the surgical procedure (nephrectomy or adrenalectomy).

Main Results:

• Twenty-four of 62 patients had prior abdominal surgery; 20% required open insertion of the mesh sleeve.
• Liver puncture occurred in 9% of cases but did not necessitate conversion to open surgery.
• No access-related complications or port-site hernias were observed at a mean 12-month follow-up.

Conclusions:

• Subcostal midclavicular line initial access helps prevent visceral injury, particularly in patients with prior abdominal surgery.
• The radially expanding access system with modified port placement offers safe and rapid laparoscopic access for upper urinary tract procedures.
• This system is a viable alternative to standard laparoscopic trocars.