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JSLS. 2014 Oct-Dec;18(4). pii: e2014.00144. doi: 10.4293/JSLS.2014.00144.

Hybrid transureteral nephrectomy in a survival porcine model.

Author information

1
Department of Urology, Loma Linda University Medical Center, Loma Linda, California, USA.

Abstract

BACKGROUND AND OBJECTIVES:

Natural-orifice approaches for nephrectomy have included access via the stomach, vagina, bladder, and rectum. Recently, the feasibility of using the ureter as a natural orifice for natural-orifice transluminal endoscopic surgery nephrectomy has been demonstrated in a nonsurvival porcine model. The purpose of this study was to assess the outcomes of transureteral laparoscopic natural-orifice transluminal endoscopic surgery nephrectomy in a survival porcine model.

METHODS:

Three pigs underwent hybrid transureteral natural-orifice transluminal endoscopic surgery nephrectomy. An experimental balloon/dilating sheath was inserted over a wire to dilate the urethra, ureteral orifice, and ureter. Through a bariatric 12-mm laparoscopic port, the ureter was opened medially and the hilar dissection was performed. Next, 2 needlescopic ports were placed transabdominally to facilitate hilar transection. The kidney was morcellated using a bipolar sealing device and extracted via the ureter using the housing of a bariatric stapling device. The ureteral orifice was closed with a laparoscopic suturing device. The bladder was drained by a catheter for 10 to 14 days postoperatively. Pigs were euthanized on postoperative day 21.

RESULTS:

All surgical procedures were successfully completed, with no intraoperative complications. One pig had an episode of postoperative clot retention that resolved with catheter irrigation. Each pig was healthy and eating a normal diet prior to euthanasia.

CONCLUSIONS:

This study demonstrates the feasibility of a hybrid transureteral approach to nephrectomy in a survival porcine model. This technique avoids the intentional violation of a second organ system and the risk for peritoneal contamination. Improved instrumentation is needed prior to implementation in the human population.

KEYWORDS:

Investigational therapy; Minimally invasive surgery; Natural-orifice endoscopic surgery; Nephrectomy

PMID:
25489210
PMCID:
PMC4254474
DOI:
10.4293/JSLS.2014.00144
[Indexed for MEDLINE]
Free PMC Article

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