Single port transumbilical (E-NOTES) donor nephrectomy.
OBJECTIVE
We present the initial 4 patients undergoing single port transumbilical live donor nephrectomy. Scar-free abdominal surgery via natural body orifices is called NOTES (natural orifice translumenal endoscopic surgery). In a similar manner the umbilicus, an embryonic (E) natural orifice, permits abdominal access with hidden scar of entry. We propose the term E-NOTES for embryonic natural orifice transumbilical endoscopic surgery.


METHODS
Through an intra-umbilical incision a novel single access tri-lumen R-port was inserted into the abdomen. No extra-umbilical skin incisions were made whatsoever. A 2 mm Veress needle port, inserted via skin needle puncture to establish pneumoperitoneum, was used to selectively insert a needlescopic grasper for tissue retraction. Donor kidney was pre-entrapped and extracted transumbilically.


RESULTS
E-NOTES donor nephrectomy was successful in all 4 patients. Median operating time was 3.3 hours, blood loss was 50 cc, warm ischemia time was 6.2 minutes and hospital stay was 3 days. Median length of harvested renal artery was 3.3 cm, renal vein 4 cm and ureter 15 cm. No intraoperative complications occurred. Donor visual analog scores were 0/10 at 2 weeks. Each allograft functioned immediately on transplantation.


CONCLUSIONS
The initial experience with E-NOTES donor nephrectomy is encouraging. Excellent donor vascular and tissue dissection could be performed, and a quality donor kidney was retrieved transumbilically without any extra-umbilical skin incision. E-NOTES donor nephrectomy appears to have relevance and promise, especially for this typically younger, altruistic population. Natural orifices present an unprecedented opportunity for scar-free surgery.
Gill
Inderbir S
IS
Center for Laparoscopic and Robotic Surgery, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA. gilli@ccf.org
Canes
David
D
Aron
Monish
M
Haber
Georges-Pascal
GP
Goldfarb
David A
DA
Flechner
Stuart
S
Desai
Mahesh R
MR
Kaouk
Jihad H
JH
Desai
Mihir M
MM
D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D018570:Risk Assessment; D013536:Suture Techniques; D014472:Umbilicus