Assessment of the feasibility and impact of intra-corporeal renal perfusion with hypertonic saline solution in reducing the incision in pigs underwent single port nephrectomy

Abstract

Over the past 20 years laparoscopy has become worldwide the technique of choice to perform nephrectomy, both for benign and malignant diseases due to the advantages of a minimally invasive procedure. However, the removal of surgical specimens still requires an incision of 5 to 10 cm, which harm a little the recovery much for aesthetics as for the effects of incision. Recently, a variation of laparoscopy (single port: several laparoscopic instruments through the same incision 2.5 to 3 cm) was described as a less invasive technique, however the benefits have not been scientifically demonstrated, probably because is necessary to make an open incision to 10 cm to remove the specimen. Therefore, we propose a unique project that will test the effect of renal shrinking by intracorporeal 5% hypertonic saline infusion, described by our group, to reduce the incision to remove the kidney in laparoscopic surgery using single port device. Objective: To evaluate the feasibility of performing intracorporeal infusion by single port and compare the length of the incision needed for extraction after laparoscopic nephrectomy through single port in pigs submitted to renal shrinkage after 5% hypertonic saline with those not perfused. Material and methods: An experimental study with 20 porcine models undergoing single port bilateral laparoscopic nephrectomy which one kidney will not be submitted to any intracorporeal perfusion technique and the other will be perfused with 5% saline. In each side the single port will be placed in the ipsilateral nipple line, where the specimen is removed and scaled the size of the incision necessary for complete removal. Will be compared the size of abdominal incision to remove the kidneys underwent perfusion and those non-perfused kidney. The volumes, length of renal vessels and ureter and trans-operatory parameters as the time needed for the beginning and end of the procedure and perioperative bleeding. Discussion: This innovative project will bring together the merger of a new laparoscopic technique that is already being applied in other centers, including kidney donors using single port device with the experimental test of intra-corporeal renal shrinkage with hypertonic saline. Determine the impact of renal shrinkage hypertonic solution in operative morbidity, especially in the size of the incision needed to remove the organ, becomes to amplify the benefits of minimally invasive surgery. (AU)