Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report

To report the initial clinical cases of scarless, single port, transumbilical nephrectomy and pyeloplasty. One patient each underwent single port transumbilical nephrectomy and pyeloplasty using the R-Port (Advanced Surgical Concepts), inserted through a transumbilical incision in both cases. Novel, specialized instruments, curved at the shaft, were used in addition to standard laparoscopic instrumentation. During pyeloplasty, a 2-mm needle-port (MiniSite, USSC, Norfolk, CT, USA) was also inserted, with no skin incision, to facilitate suturing. Both procedures were technically successful with no extra-umbilical skin incisions. The total operative duration was 3.4 and 2.7 h, the estimated blood loss 100 and 50 mL, and the hospital stay was 1 and 2 days for the nephrectomy and pyeloplasty, respectively. There were no complications during or after surgery. The total analgesia requirement was 100 and 150 mg of keterolac, and visual analogue pain scores were 8/10 and 2/10 at 1 and 2 days after surgery, respectively. Transumbilical, single port nephrectomy and pyeloplasty are technically feasible. The first initial clinical experience of organ-ablative and reconstructive renal surgery with this approach is reported.