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Related Experiment Videos

Single port transumbilical (E-NOTES) donor nephrectomy.

Inderbir S Gill1, David Canes, Monish Aron

  • 1Center for Laparoscopic and Robotic Surgery, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA. gilli@ccf.org

The Journal of Urology
|June 17, 2008
PubMed
Summary
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Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) enabled scar-free donor nephrectomy in four patients. This novel technique shows promise for minimally invasive kidney donation with excellent outcomes and patient recovery.

Area of Science:

  • Minimally Invasive Surgery
  • Transplant Surgery
  • Endoscopic Surgery

Background:

  • Natural Orifice Translumenal Endoscopic Surgery (NOTES) aims for scar-free abdominal procedures.
  • The umbilicus, an embryonic natural orifice, offers a unique access point for minimally invasive surgery.
  • Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) is proposed for scar-free abdominal access.

Purpose of the Study:

  • To present the initial outcomes of four patients undergoing single-port transumbilical live donor nephrectomy using the E-NOTES technique.
  • To evaluate the feasibility and safety of E-NOTES for donor nephrectomy.

Main Methods:

  • A novel single-access tri-lumen R-port was inserted through an intra-umbilical incision.
  • No additional extra-umbilical skin incisions were made.

Related Experiment Videos

  • Needlescopic graspers were used for tissue retraction, and the donor kidney was extracted transumbilically.

    • Main Results:

    • E-NOTES donor nephrectomy was successfully performed in all four patients.
    • Median operative time was 3.3 hours, with 50 cc blood loss and a 3-day hospital stay.
    • No intraoperative complications occurred, and allografts functioned immediately post-transplantation with excellent donor recovery.

    Conclusions:

    • Initial experience with E-NOTES donor nephrectomy is encouraging, demonstrating successful kidney retrieval with excellent donor outcomes.
    • The technique allows for quality donor kidney dissection and extraction without visible scarring.
    • E-NOTES holds significant promise for scar-free kidney donation, particularly for younger, altruistic donors.