Transureteral Natural Orifice Translumenal Endoscopic Surgery Nephrectomy: A Feasibility Study in the Porcine Model

Aim: Natural orifice approaches for nephrectomy have included access via the stomach, vagina, bladder, and rectum. The use of the ureter as a natural orifice for natural orifice translumenal endoscopic surgery (NOTES) nephrectomy has not previously been reported. The aim of this study was to test the feasibility of transureteral laparoscopic NOTES nephrectomy. Materials and Methods: Three female farm pigs (29.2–30.8 kg) were placed into the lithotomy position. A cystoscopically placed extra-stiff guide wire was used to place a prototype dilating sheath into the left ureter. After dilation of the ureter and urethra, the sheath was exchanged for a 12-mm bariatric laparoscopic trocar. A 10.5-inch-long, 10-mm offset operating laparoscope with an internal 5-mm working port was utilized for the nephrectomy. One 2-mm and one 2/3-mm port were placed transabdominally to facilitate in situ morcellation. The kidney was cut into slices using the bipolar device and extracted via the ureteral port using the ho...