NOTES Transvaginal Nephrectomy

First Human Experience

Jihad H. Kaouk, Wesley White, Raj K. Goel, Stacy Brethauer, Sebastien Crouzet, Raymond R. Rackley, Courtenay Moore, Michael S. Ingber, Georges Pascal Haber

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Objectives: To present the operative outcomes of the first natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy. Methods: A 57-year-old woman with hypertension, right-sided flank pain, and radiographic evidence of an atrophic right kidney consented for NOTES transvaginal nephrectomy. Pneumoperitoneum was achieved with a Veress needle inserted deep in the umbilicus. Under direct vision, a colpotomy was made and a transvaginal port positioned. Using standard and articulating operating instruments inserted transvaginally, the kidney was mobilized and the renal hilum was controlled with an endovascular stapler. The kidney was placed in a laparoscopic retrieval bag and extracted through the vaginal incision. Salient demographic and operative data were obtained. Results: NOTES transvaginal nephrectomy was successfully completed, with all the operative steps performed transvaginally. Dense pelvic adhesions from a prior hysterectomy necessitated the use of a 5-mm umbilical port during vaginal port placement and for retraction of the ascending colon during division of the renal hilum. No intraoperative complications occurred. Operative time was 307 minutes, with 124 minutes dedicated to vaginal port placement and 183 minutes dedicated to adhesiolysis and nephrectomy. The duration of hospitalization was 23 hours. The visual analog pain scale score was 1 of 10 on postoperative day 2. Conclusions: Our experience shows that NOTES transvaginal nephrectomy is technically feasible. Access to the peritoneal cavity should be performed under visual guidance and after insufflation through the umbilicus. Additional experience is needed to better define patient selection criteria and indications for NOTES transvaginal urologic surgery.

Original languageEnglish (US)
Pages (from-to)5-8
Number of pages4
JournalUrology
Volume74
Issue number1
DOIs
StatePublished - Jul 1 2009
Externally publishedYes

Fingerprint

Natural Orifice Endoscopic Surgery
Nephrectomy
Umbilicus
Kidney
Patient Selection
Colpotomy
Flank Pain
Ascending Colon
Insufflation
Pneumoperitoneum
Intraoperative Complications
Peritoneal Cavity
Pain Measurement
Operative Time
Hysterectomy
Needles
Hospitalization
Demography
Hypertension

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Kaouk, J. H., White, W., Goel, R. K., Brethauer, S., Crouzet, S., Rackley, R. R., ... Haber, G. P. (2009). NOTES Transvaginal Nephrectomy: First Human Experience. Urology, 74(1), 5-8. https://doi.org/10.1016/j.urology.2009.03.030

NOTES Transvaginal Nephrectomy : First Human Experience. / Kaouk, Jihad H.; White, Wesley; Goel, Raj K.; Brethauer, Stacy; Crouzet, Sebastien; Rackley, Raymond R.; Moore, Courtenay; Ingber, Michael S.; Haber, Georges Pascal.

In: Urology, Vol. 74, No. 1, 01.07.2009, p. 5-8.

Research output: Contribution to journalArticle

Kaouk, JH, White, W, Goel, RK, Brethauer, S, Crouzet, S, Rackley, RR, Moore, C, Ingber, MS & Haber, GP 2009, 'NOTES Transvaginal Nephrectomy: First Human Experience', Urology, vol. 74, no. 1, pp. 5-8. https://doi.org/10.1016/j.urology.2009.03.030
Kaouk JH, White W, Goel RK, Brethauer S, Crouzet S, Rackley RR et al. NOTES Transvaginal Nephrectomy: First Human Experience. Urology. 2009 Jul 1;74(1):5-8. https://doi.org/10.1016/j.urology.2009.03.030
Kaouk, Jihad H. ; White, Wesley ; Goel, Raj K. ; Brethauer, Stacy ; Crouzet, Sebastien ; Rackley, Raymond R. ; Moore, Courtenay ; Ingber, Michael S. ; Haber, Georges Pascal. / NOTES Transvaginal Nephrectomy : First Human Experience. In: Urology. 2009 ; Vol. 74, No. 1. pp. 5-8.
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