Single-Port Donor Nephrectomy via Modified Pfannenstiel Incision: Initial Preclinical Experience in a Cadaveric Model and Description of Technique

Objective: To describe the surgical technique for the single-port (SP) transperitoneal donor nephrectomy (DN) through a modified Pfannenstiel incision using the Da Vinci SP(R) surgical system (Intuitive Surgical, Sunnyvale, CA) on a cadaver.Patients and Methods: In a male cadaver, the SP surgical system was used to perform transperitoneal DN. A 3-cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25-mm multichannel port and a 12-mm assistant port were introduced. The surgical steps for DN were performed in the following order: (1) mobilization of the colon, (2) identification of psoas muscle, ureter, and the gonadal vein, (3) hilum dissection, (4) perirenal dissection, (5) stapling the renal artery and renal vein, and (6) removal of the kidney through the enlarged incision.Results: Transperitoneal SP DN was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm.Conclusion: We demonstrated the feasibility of SP transperitoneal DN through modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.