title: Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device.
abstract: BACKGROUND
  Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a procedure in evolution. Currently described techniques utilize single port access devices and articulating, flexible, and bent working instruments. We describe a modified technique of transumbilical LESS-DN with conventional laparoscopic instruments in five kidney donors.
  
  
  METHODS
  Three standard laparoscopic ports (10 mm × 1, 5 mm × 2) were placed through a 4.5 cm vertical transumbilical incision. A 10 mm 45°, long bariatric lens (Karl Storz) was used. Renal mobilization was performed using conventional rigid laparoscopy instruments. A port closure needle loaded with a blunt plastic needle cap was used for traction. After hilar clamping, an incision was made connecting the three ports, and the kidney was extracted using a preplaced suture over the lower pole fat. All data were prospectively recorded.
  
  
  RESULTS
  LESS-DN was performed successfully in all five patients. The mean operative time was 157.2 minutes (range, 134-184) and the mean warm ischemia time was 3.2 minutes (range, 3-4). All donors were discharged on postoperative day 3 and were able to resume normal physical activity by 2 weeks after the procedure. All donors had an excellent cosmetic outcome. The mean serum creatinine (recipient) at discharge was 1.14 mg% (range, 0.9-1.4).
  
  
  CONCLUSIONS
  Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.
authors.affiliation: Department of Urology and Surgical Gastro-enterology, Manipal Hospital, Airport Road, Bangalore, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Dubey
authors.forename: R P
authors.initials: RP
authors.lastname: Shrinivas
authors.forename: G
authors.initials: G
authors.lastname: Srikanth