[Transumbilical laparoscopic simple nephrectomy using a flexible cystoscope and standard laparoscopic instruments]. / Nefrectomía simple laparocópica transumbilical con el uso de cistoscopio flexible e instrumentos laparsocópicos estándar.

OBJECTIVES: We present our initial experience with transumbilical surgery in a simple nephrectomy performed with a flexible cystoscope and standard laparoscopic instruments. METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus) and the other the entrance of the PKS Plasma Trissector. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the lef-upper quadrant and progressed directly into de peritoneal cavity under direct vision. RESULTS: The standard laparoscopic steps were duplicated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed. CONCLUSION: Single port urologic surgery will expand in the future. There is lack of commercial availability of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in different settings.

Nefrectomía simple laparoscópica transumbilical con el uso de cistoscopio flexible e instrumentos laparoscópicos estándar / Transumbilical laparoscopic simple nephrectomy using a flexible cystoscope and standard laparoscopic instruments

Objetivo: Presentar nuestra experiencia inicial con la cirugía transumbilical en una nefrectomía simple realizada con un cistoscopio flexible e instrumentos laparoscópicos estándar.MÉTODOS: Paciente de 15 años de edad, con diagnóstico de atrofia renal izquierda, secundaria a infección urinaria recurrente. Se decidió una nefrectomía simple y se planeó realizarla por vía laparoscópica a través de un puerto único. En posición de lumbotomía y a través de una incisión transumbilical de 3 cm., dos puertos de 5mm fueron colocados en el ombligo. Un trócar permite la progresión del cistoscopio flexible (Olympus ®) y el otro la entrada del disector bipolar Este último fue cambiado por un puerto de 10 mm para permitir la entrada de los clips de Weck. Se introdujo un grasper Maryland en el cuadrante superior izquierdo, sin puerto, para la contra tracción, el cual fue avanzado directamente en la cavidad peritoneal bajo visión directa.RESULTADO: Los pasos estándar de la cirugía laparoscópica se replicaron sin inconvenientes. El tiempo quirúrgico fue de 90 minutos y la pérdida sanguínea de 200 ml. La estadía hospitalaria fue de 18 horas. No se necesitó transfusión.CONCLUSIONES: La cirugía urológica de puerto único se ampliará en el futuro. Hay una falta de disponibilidad comercial de los insumos ideales para el desarrollo de esta cirugía. La versatilidad de los instrumentos urológicos permitirá su uso en diferentes contextos(AU)

Summary.- OBJECTIVES:We present our initial expe-rience with transumbilical surgery in a simple nephrec-tomy performed with a flexible cystoscope and standard laparoscopic instruments.METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus®) and the other the entrance of the PKS Plasma Trissecdificultator®. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the left-upper quadrant and progressed directly into de peritoneal cavity under direct vision.RESULTS: The standard laparoscopic steps were dupli-cated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed.CONCLUSION: Single port urologic surgery will ex-pand in the future. There is lack of commercial availa-bility of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in di-fferent settings(AU)