title: Rapid communication: transvaginal single-port NOTES nephrectomy: initial laboratory experience.
abstract: OBJECTIVE
  Natural orifice translumenal endoscopic surgery (NOTES) using purpose-built equipment has never been applied to urologic surgery. Herein, we present our initial experience with a trans-vaginal single-port NOTES nephrectomy.
  
  
  RESULTS
  An acute experiment was performed in a female farm pig. A single 12-mm trocar was placed in the midline and the TransPort Multi-Lumen Operating Platform (USGI Medical, San Clemente, CA) was passed transvaginally. This flexible device has four working channels and can be locked into position, thereby creating a rigid multitasking platform that allows two-handed tissue manipulation. Dissection was performed using an endoscopic needle knife and a tissue grasper for retraction. Via the 12-mm port, the renal artery and vein were taken separately with a vascular EndoGIA and standard laparoscopic titanium clips, respectively. The kidney was placed in a 10-mm EndoPouch retriever and removed intact via the vagina. The total operative time was 300 minutes.
  
  
  CONCLUSIONS
  Transvaginal NOTES nephrectomy can be accomplished in a porcine model. Additional testing on survival animals is necessary to validate this approach.
authors.affiliation: Department of Urology, Division of Gastroenterology, University of California, Irvine, Orange, California 92868, USA. rclayman@uci.edu
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Box
authors.forename: Jose Benito A
authors.initials: JB
authors.lastname: Abraham
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Deane
authors.forename: Eric R
authors.initials: ER
authors.lastname: Sargent
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chang
authors.forename: Amy K
authors.initials: AK
authors.lastname: Tan
authors.forename: Lee E
authors.initials: LE
authors.lastname: Ponsky
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
mesh_terms: D000818:Animals; D004724:Endoscopy / Q000379:methods*; D005260:Female; D009392:Nephrectomy / Q000379:methods*; D010537:Peritoneum / Q000601:surgery; D012077:Renal Artery / Q000601:surgery; D013552:Swine; D014513:Ureter / Q000601:surgery