Transumbilical Laparoscopic Bilateral Nephrectomy

Introduction: Traditionally, the laparoscopic surgeries use several trocars (three to six) introduced by transperitoneal or retroperitoneal access, depending on the type and the complexity of the procedure. Thus, the optimum triangulation is reached. That triangulation has been considered an essential pre requisite for the complex surgical procedures that need precise dissections and suturing techniques. Lately some authors have attempted to reduce even more the morbidity of the laparoscopy carrying mini-laparoscopy surgeries through natural orifices and transumbilical access. The intention of this article is to describe a case of bilateral nephrectomy for instrumental laparoscopic transumbilical access using of conventional laparoscopic surgery. Case report: 60-year-old female patient, who underwent renal transplant with graft in the right iliac fossa, was directed to our group by the nephrology service due to repetition urinary tract infection and bilateral renal atrophy. An evaluation of the possibility of proceeding bilateral laparoscopic nephrectomy was carried out, and based on this pre-surgery evaluation, the indicated procedure was through transumbilical access. After the confection of the pneumoperitoneum, three trocars had been located within the periumbilical region and the surgery was successfully carried through without the use of any articulated laparoscopic instrument. The operative time was 100 minutes, with an estimated 100 ml blood loss. The patient got discharged from the hospital on the second day of the postoperative period. Conclusion: The accomplishment of bilateral nephrectomy through transumbilical laparoscopic access is feasible and this access can be considered an alternative to the traditional laparoscopy, even when special articulated laparoscopic instruments are not available.