Transumbilical single-port laparoscopic partial nephrectomy

To present the initial experience with laparoscopic partial nephrectomy (LPN) performed through a transumbilical single port. Between November 2007 and April 2008, five selected patients underwent single-port LPN (SPLPN) for renal tumours. All procedures were performed through a single intraumbilical multichannel laparoscopic port. A 2-mm grasper was inserted through a 2-mm Veres needle-port in the anterior axillary line to aid in tissue retraction and sutured renal reconstruction. The technique of standard multiport LPN was replicated, with the renal hilum clamped. SPLPN was successfully completed in four patients, while an additional 5-mm port was required in one patient. The median (range) tumour size was 3 (1-5.9) cm. The median (range) operating time was 270 (240-345) min and the estimated blood loss was 150 (100-600) mL. The median (range) warm ischaemia time was 20 (11-29) min. The median (range) length of the umbilical incision was 2.5 (2.5-4) cm. The median (range) hospital stay was 3(3-22) days. There were no intraoperative complications. All surgical margins were negative for tumour. There were no postoperative complications in four patients. One patient had postoperative bleeding and pulmonary embolism. SPLPN is technically feasible, albeit more challenging than conventional LPN. Proper case selection is essential. Advances in single-port specific instrumentation are needed before these procedures can become a part of mainstream urological laparoscopy.