Transvaginal nephrectomy with a multichannel laparoscopic port: a cadaver study

Area of Science:

• Surgical innovation
• Minimally invasive surgery
• Natural orifice transluminal surgery (NOTES)

Background:

• Transvaginal nephrectomy (TN) is an emerging Natural Orifice Transluminal Surgery (NOTES) procedure.
• Novel port systems are needed to facilitate complex NOTES procedures like TN.

Purpose of the Study:

• To evaluate the feasibility of using the novel QuadPort for transvaginal nephrectomy (TN).
• To assess the utility of standard and articulating laparoscopic instruments in TN via the QuadPort.

Main Methods:

• Four female cadavers underwent transvaginal nephrectomy (TN) procedures.
• A novel QuadPort was placed transvaginally, with an umbilical R-port for monitoring.
• Standard laparoscopic instruments were utilized for dissection and specimen extraction.

Main Results:

• Three out of four transvaginal nephrectomies (TN) were successfully completed.
• Dense adhesions in one cadaver necessitated abortion of the procedure.
• Dissection of upper pole attachments required umbilical port assistance or a flexible gastroscope.

Conclusions:

• Completely NOTES-based TN in humans presents significant challenges.
• Robust laparoscopic instruments are essential for transvaginal procedures via multichannel ports.
• Development of novel, flexible instruments is needed for difficult dissections in NOTES TN.