Third-generation nephrectomy by natural orifice transluminal endoscopic surgery.

Area of Science:

• Minimally Invasive Surgery
• Surgical Innovation
• Experimental Surgery

Background:

• Transgastric surgery is gaining traction for abdominal procedures.
• Previous research established a combined transgastric and transvesical approach for cholecystectomy.
• Assessing feasibility for more complex procedures like nephrectomy is the next step.

Purpose of the Study:

• To evaluate the feasibility of a combined transgastric and transvesical approach for nephrectomy.
• To assess this novel technique in a porcine model for a complex surgical procedure.

Main Methods:

• A nonsurvival study was conducted on 6 female pigs.
• Transvesical and transgastric access routes were established.
• Nephrectomy was performed using instruments introduced via both access routes, guided by ureteroscope and gastroscope.

Main Results:

• Four right and two left nephrectomies were successfully completed without access complications.
• Kidneys were visualized, and renal vessels/ureters were dissected and ligated.
• Initial hemorrhage was managed by applying clips before ultrasonic ligation, enabling complete renal mobilization.

Conclusions:

• Combined transgastric and transvesical nephrectomy is technically feasible in a porcine model.
• Current instrumentation presents limitations for reliable specimen retrieval.