Objective: To describe a modification of the posterior prone retroperitoneoscopic nephrectomy, which allows the entire operation to be performed through a single instrument port.
Patients and methods: With the patient prone, a retroperitoneal working space is created using a custom-made balloon lateral to the sacrospinalis muscle. One instrument port is placed at the tip of the 11th rib under direct vision. The laparoscope and working instrument can both be held by the operating surgeon. Gerota's fascia is incised and the kidney reflected anteriorly. The vessels are identified and divided. The remaining dissection is completed with a harmonic scalpel and the specimen is placed in an endo-catch bag. Care must be taken to avoid even minor bleeding, to keep the operating field clear.
Results: The technique was successful in 54 children with a mean (range) age of 4.5 (0.25-14) years; the mean operative duration was 52 (35-96) min. Blood loss was minimal and there were no open conversions. Most children (51) were discharged the day after surgery, and the cosmetic outcome has been excellent in all cases.
Conclusions: Compared with the traditional approach, the single-instrument port laparoscopic (SImPL) nephrectomy approach avoids instrument crowding and maximizes the restricted retroperitoneal working space. Avoiding the second port might improve cosmesis and reduce cost. The technique is quickly mastered by both the experienced laparoscopist and trainee, and is feasible and safe.