title: [Hybrid-NOTES transvaginal hemi-nephrectomy for duplicated renal collecting system in the adult patient].
abstract: BACKGROUND
  Duplication of the ureter and renal pelvis is the most common anomaly of the upper urinary tract. Upper pole heminephrectomy is a treatment option when duplication anomalies are associated with ureteral ectopia or ureterocele with an associated nonfunctioning or infected upper pole moiety.
  
  
  METHODS
  We describe a NOTES hybrid transvaginal upper pole heminephrectomy in a 24 year old with recurrent infections in a poorly functioning right upper pole moiety. The procedure was performed with a bariatric trocar in the vagina, and a multichannel single-port device (Triport, Olympus Surgical) in the umbilicus. An ultrasonic scalpel was used for the heminephrectomy. The specimen was retrieved through the vagina.
  
  
  RESULTS
  Operative time was 150 minutes and blood loss 50 cc. One week later the patient developed urinoma at the surgical site and was re-explored laparoscopically. The cut edge of the heminephrectomy defect was fulgurated and a drain placed. The patient recovered uneventfully following re-exploration.
  
  
  CONCLUSIONS
  We describe the technique for transvaginal Hybrid-NOTES heminephrectomy. This approach requires further development with respect to instrumentation, and surgical expertise. The combined umbilical and vaginal approached restored triangulation and facilitates dissection, but more experience is required to determine safety, efficacy and reproducibility.
authors.affiliation: Instituto Médico La Floresta, Caracas, Venezuela. renesotelo@cantv.net
authors.forename: R
authors.initials: R
authors.lastname: Sotelo
authors.forename: C
authors.initials: C
authors.lastname: Giedelman
authors.forename: O
authors.initials: O
authors.lastname: Carmona
authors.forename: R
authors.initials: R
authors.lastname: de Andrade
authors.forename: D
authors.initials: D
authors.lastname: Ramírez
mesh_terms: D004322:Drainage; D004954:Esthetics; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery / Q000628:therapy; D007685:Kidney Tubules, Collecting / Q000002:abnormalities / Q000601:surgery*; D010535:Laparoscopy; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D014464:Ultrasonic Therapy; D014552:Urinary Tract Infections / Q000209:etiology; D053584:Urinoma / Q000209:etiology / Q000601:surgery; D014621:Vagina; D055815:Young Adult