title: Single access site laparoscopic radical nephrectomy: initial clinical experience.
abstract: OBJECTIVE
  We present the initial clinical experience with single access site (SAS) laparoscopic radical nephrectomy.
  
  
  METHODS
  An 86-year-old woman presented with an 8-cm central-enhancing right renal lesion. The patient elected to undergo a laparoscopic radical nephrectomy. A 7-cm paramedian incision was made just lateral to the left rectus muscle and cranial to the umbilicus. A GelPort was inserted into the incision. Three trocars (12 mm, 10 mm, and 5 mm) were placed through the access port, and only standard laparoscopic instruments were used. The kidney was mobilized in the standard fashion. Controlling the renal artery with nonabsorbable polymer clips and the renal vein with a stapling device, the specimen was manipulated into a laparoscopic retrieval bag and removed intact. Hemostasis was confirmed, the GelPort was removed, and the 7-cm incision was closed.
  
  
  RESULTS
  The procedure was completed in 96 minutes without complications. Blood loss was estimated to be 10 mL. Postoperatively, the patient was treated with intermittent intravenous and oral analgesics. She was discharged on postoperative day 2 and tolerated a regular diet.
  
  
  CONCLUSIONS
  This represents the initial report of an SAS laparoscopic radical nephrectomy, with intact specimen extraction. Using standard laparoscopic instrumentation, the procedure was performed safely and effectively, with minimal blood loss, and short hospitalization. Additional evaluation and development of this type of approach and instrumentation may allow for further expansion of SAS laparoscopic surgery in the future.
authors.affiliation: Center for Urologic Oncology and Minimally Invasive Therapies, Department of Urology, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA. lee.ponsky@uhhospitals.org
authors.forename: Lee E
authors.initials: LE
authors.lastname: Ponsky
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cherullo
authors.forename: Mark
authors.initials: M
authors.lastname: Sawyer
authors.forename: David
authors.initials: D
authors.lastname: Hartke
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*