Sotelo R, Giedelman C, Carmona O, de Andrade R, Ramírez D
Instituto Médico La Floresta, Caracas, Venezuela.
Actas Urol Esp. 2011 Jun;35(6):363-7. doi: 10.1016/j.acuro.2011.01.018. Epub 2011 Apr 13.
Duplication of the ureter and renal pelvis is the most common anomaly of the upper urinary tract. Upper pole heminephrectomy is a treatment option when duplication anomalies are associated with ureteral ectopia or ureterocele with an associated nonfunctioning or infected upper pole moiety.
We describe a NOTES hybrid transvaginal upper pole heminephrectomy in a 24 year old with recurrent infections in a poorly functioning right upper pole moiety. The procedure was performed with a bariatric trocar in the vagina, and a multichannel single-port device (Triport, Olympus Surgical) in the umbilicus. An ultrasonic scalpel was used for the heminephrectomy. The specimen was retrieved through the vagina.
Operative time was 150 minutes and blood loss 50 cc. One week later the patient developed urinoma at the surgical site and was re-explored laparoscopically. The cut edge of the heminephrectomy defect was fulgurated and a drain placed. The patient recovered uneventfully following re-exploration.
We describe the technique for transvaginal Hybrid-NOTES heminephrectomy. This approach requires further development with respect to instrumentation, and surgical expertise. The combined umbilical and vaginal approached restored triangulation and facilitates dissection, but more experience is required to determine safety, efficacy and reproducibility.
输尿管和肾盂重复是上尿路最常见的异常。当上极半肾切除术与输尿管异位或输尿管囊肿相关，且伴有无功能或感染的上极部分时，是一种治疗选择。
我们描述了一例24岁女性NOTES混合经阴道上极半肾切除术，其右侧上极部分功能不佳且反复感染。手术通过在阴道使用减重套管针，并在脐部使用多通道单孔装置（Triport，奥林巴斯外科）进行。使用超声刀进行半肾切除术。标本通过阴道取出。
手术时间为150分钟，失血50毫升。一周后患者手术部位出现尿瘤，接受腹腔镜再次探查。对上极半肾切除缺损的切缘进行电凝，并放置引流管。再次探查后患者顺利康复。
我们描述了经阴道混合NOTES半肾切除术的技术。这种方法在器械和手术专业知识方面需要进一步发展。脐部和阴道联合入路恢复了三角定位并便于解剖，但需要更多经验来确定安全性、有效性和可重复性。
