Rapid communication: transvaginal single-port NOTES nephrectomy: initial laboratory experience.
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.
Clayman
Ralph V
RV
Department of Urology, Division of Gastroenterology, University of California, Irvine, Orange, California 92868, USA. rclayman@uci.edu
Box
Geoffrey N
GN
Abraham
Jose Benito A
JB
Lee
Hak J
HJ
Deane
Leslie A
LA
Sargent
Eric R
ER
Nguyen
Ninh T
NT
Chang
Kenneth
K
Tan
Amy K
AK
Ponsky
Lee E
LE
McDougall
Elspeth M
EM
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