A 3 trocar technique for transperitoneal laparoscopic nephrectomy

Purpose: Additional trocars and retractor instruments may enhance the risk of iatrogenic injuries during laparoscopic nephrectomy, We describe a modif ied technique of laparoscopic nephrectomy requiring only 3 ports of entry a nd no extra instruments instead of the 5 ports, 2 of which are used for ret ractors, usually required. Materials and Methods: With the patient in full flank position a 10 mm. tro car is inserted between the umbilicus and subcostal margin, a 5 mm. trocar is placed subcostal in the midclavicular line and a 12 mm. trocar is insert ed over the iliac crest in the anterior axillary line. The first step is in cision of the line of Toldt, and medial reflection of the colon. During the second step of vascular controls the posterosuperior attachments of the ki dney are left untouched, keeping the renal vessels stretched, with no need for an extra instrument. The third step consists of severing the remaining posterior and superior attachments of the kidney followed by specimen retri eval. A total of 14 consecutive patients underwent laparoscopic nephrectomy with this technique. Results: All 14 procedures were completed without an additional port. There were no intraoperative or postoperative complications, except 1 abdominal wall hematoma. Mean operating time was 120 minutes (range 70 to 230) and me an hospital stay was 5 days (range 3 to 7). Conclusions: Transperitoneal laparoscopic nephrectomy with laparoscopic acc ess limited to 3 trocars is a reliable and safe technique.