title: Percutaneous ureteral elevation in laparoendoscopic single-site radical nephrectomy.
abstract: OBJECTIVE
  To describe our technique of suture-assisted ureteral retraction during Laparoendoscopic Single-Site (LESS) radical nephrectomy.
  
  
  METHODS
  A healthy, 39-year-old woman with an incidental 5-cm enhancing left renal mass elected to undergo radical nephrectomy. A 2-cm skin incision was made in the left upper quadrant of the abdomen, and a Covidien SILS port was introduced using standard Hasson techniques. Straight and angled laparoscopic instruments were used to mobilize the kidney outside of Gerota's fascia. To place the renal vessels on stretch and facilitate hilar dissection, the ureter and lower pole attachments were encircled with a 0-Vicryl suture inserted percutaneously via a disposable fascial closure device. The kidney was bagged and removed intact.
  
  
  RESULTS
  The procedure was performed without complication with a total operative time of 265 minutes. EBL was minimal at 25 mL. The patient was discharged home on postoperative day 1, and final pathology revealed stage pT1b chromophobe renal cell carcinoma with negative surgical margins.
  
  
  CONCLUSIONS
  LESS radical nephrectomy is feasible in select patients. Suture-assisted retraction of the ureter and lower pole attachments using a fascial closure device facilitates safe dissection and control of the renal hilum.
authors.affiliation: Division of Urology, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA. SShah@salud.unm.edu
authors.forename: Satyan K
authors.initials: SK
authors.lastname: Shah
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Ming
authors.forename: Moben
authors.initials: M
authors.lastname: Mirza
authors.forename: Anthony Y
authors.initials: AY
authors.lastname: Smith
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000601:surgery*