Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy.
BACKGROUND
Recently, the feasibility of a transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy was demonstrated in a 23-yr-old woman with a nonfunctional atrophic kidney.


OBJECTIVE
To evaluate the feasibility and reproducibility of transvaginal NOTES-assisted laparoscopic nephrectomy in female patients with and without renal cancer.


METHODS
Between March 2008 and June 2009, 14 female patients were submitted to transvaginal NOTES-assisted laparoscopic nephrectomy for T1-T3a N0M0 renal cancer (n=10), lithiasis (n=2), or renal atrophy (n=2) at the Hospital Clinic of Barcelona, Spain.


METHODS
Under general anaesthesia, female patients underwent laparoscopic nephrectomy by transvaginal NOTES using a deflectable camera by vaginal access and two additional 5- and 10-mm trocars in the abdomen. The renal artery and vein were dissected and taken separately between clips. The dissected kidney was removed via the vagina after enlarging the vaginal trocar incision.


METHODS
All data referring to patient demographics, surgery, pathology, and perioperative outcomes were recorded.


CONCLUSIONS
The procedure was completed in all patients. The mean age of the women was 59.1 yr. The mean operative time was 132.9 min and the mean estimated blood loss was 111.2 ml. None of the patients required a blood transfusion and the use of analgesics was low. The mean hospital stay was 4 d. In one case, a major complication (a colon injury) occurred. The patient underwent surgery and a temporary colostomy was performed. The patient has already undergone reconstruction.


CONCLUSIONS
Transvaginal NOTES-assisted laparoscopic nephrectomy is feasible and reproducible and may be an alternative technique for treatment of women with renal cancer. Proper selection of patients is warranted for success of this new approach. However, longer follow-up in an increasing number of patients is needed to establish its role in the treatment of renal cancer.
Department of Urology, Hospital Clinic IDIBAPS--University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain. aalcaraz@clinic.ub.es
Antonio
A
Alcaraz
Lluís
L
Peri
Alejandro
A
Molina
Iñigo
I
Goicoechea
Eduardo
E
García
Laura
L
Izquierdo
María J
MJ
Ribal
D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D014621:Vagina