Transvaginal nephrectomy (hybrid)
As surgical techniques evolve, new opportunities arise for the development of minimally invasive operations. In an effort to develop the concept of scarless surgery, the hybrid transvaginal approach to nephrectomy has been pursued. This entails placement of working ports and specimen removal through the vagina. A multiple instrument port is placed through a single umbilical incision for the remainder of the instruments.
Our department’s technique has changed in two main aspects. First, we are now using specially made long (70cm) pre-bent instruments through the vagina. These instruments allow for easier entry and maneuverability past the pelvis into the abdomen. These instruments are typically used for retraction of tissues and organs, but may be in the future used for more active tissue manipulation. Second, we are now using specially made thin flexible ports for the placement of instruments through the vagina, instead of conventional multi-instruments ports. These individual ports offer great ease in insertion and fixation, and due to their flexibility, allow for a greater range of motion.
As can be seen in the accompanying videos, dissection of the tissues is performed through the abdominal entry site, using conventional and prebent instruments. Pre bent instruments are preferred in opposition to flexible instruments, as the latter’s flexible tip does not allow for more forceful retraction of tissues.
As the technique is still evolving, surgical steps are not listed, but the salient points may be observed in the videos.
Transvaginal Nephrectomy – Abdominal Gelpoint
Transvaginal Nephrectomy – Dissection of Toldt’s line
Transvaginal Nephrectomy – Instrument Dissection
Transvaginal Nephrectomy – Liver retraction (new trocars)
Transvaginal Nephrectomy – Dissection 2
Transvaginal Nephrectomy – Hilar dissection
Transvaginal Nephrectomy – Vessel ligation
Transvaginal Nephrectomy – Specimen extraction
Transvaginal Nephrectomy – Vaginal incision closure
Transvaginal Nephrectomy – Risk to iliac vessels