Using Conventional Instruments to Perform Single-Incision Laparoscopic Nephrectomy in Children with Congenital Dysplastic Kidneys: The Crossed-Instruments (Chopsticks) Technique

Introduction:

Single-incision laparoscopic surgery (SILS) has recently been developed as an evolution from conventional laparoscopy. Multi-luminal single-port devices and reticulating instruments are commercially available, but their size may not be appropriate in young children. We have previously described the crossed-instruments (chopsticks) technique to perform SILS in children using conventional 3- and 5-mm instruments without any additional costs for instruments. ^{1 –3} This video (run time 5:18) demonstrated how single-incision laparoscopic nephrectomy (SILN) was performed using this technique in a 4-year-old girl with multicystic dysplastic nonfunctioning left kidney at ectopic position. The procedure was performed by the author (Y.H.T.) and completed in 100 minutes.

Materials and Methods:

Our technique to perform SILN has been reported previously. ² An incision was made along the lower half of the umbilical ring. Subcutaneous tissue was mobilized to create a fascial surface for ports insertion. A 5-mm camera port was placed at 6 o'clock position. In this case of left nephrectomy, the 3- and 5-mm working ports were placed at the 9 and 3 o'clock positions, respectively. For right nephrectomy, the positions of the 3- and 5-mm working ports will be reversed. Three-millimeter straight instruments and a 5-mm vessel-sealing device were used. The surgeon and the assistant stood on the right side of the operating table, with the patient's left side being elevated. Most of the dissections were performed by the crossed-instruments technique so that the instrument on the surgeon's right hand operated on the left side of laparoscopic view and the left-handed instrument operated on the right side.

Results:

Six children, aged 3 or 4, with nonfunctioning multicystic dysplastic kidneys have undergone SILN (right, n = 4; left, n = 2) by our technique. SILN was performed either by a single surgeon (Y.H.T.) or by two surgeons (Y.H.T. and J.D.S.). There was no conversion to open surgery or conventional laparoscopy. Operative time ranged from 100 to 180 minutes. Full diet was tolerated from 24 to 48 hours after surgery. Two patients did not require any postoperative analgesics. The other four patients required two to six doses of oral acetaminophen, while one dose of narcotic analgesic was required in one patient. There was no intra- or postoperative complication. No access-site hernia has been detected after follow-up of 6–22 months.

Conclusions:

SILN can be safely and effectively performed in young children with dysplastic kidneys using conventional instruments by the crossed-instruments technique congenital nonfunctioning.

All the authors have no competing financial interests to disclose.

Runtime of video: 5 mins 18 secs