Nephropexy remains standard for symptomatic nephroptosis, and several minimally-invasive techniques have been described. Triangulation sutures placed between the abdominal wall and the renal capsule are often difficult to tie tightly due to the confined working space. We propose a technique modification to fixate the kidney utilizing the da Vinci Surgical System robot and Lapra-Ty absorbable suture clips. Four female patients with symptomatic nephroptosis diagnosed via kidney hypermobility demonstrated on intravenous urography (IVU) underwent robotic-assisted laparoscopic nephropexy (RALNP) from February 2008 to April 2010. After complete mobilization and stripping of perirenal fat, several 0 Vicryl sutures were placed in a “figure of eight” fashion and tied loosely. Subsequently we utilized a Lapra-Ty to tighten the stitch serially and fixate the kidney. The mean age was 46 years (43–52); one patient underwent simultaneous pyeloplasty and one underwent partial nephrectomy in the ipsilateral kidney. There were no intraoperative complications and two postoperative complications, both Clavien grade I. All patients were asymptomatic postoperatively at a mean follow-up of 9.2 months (1–28), and had no evidence of kidney hypermobility on upright IVU or diuretic renal scintigraphy (RS) scan at 6 weeks postoperatively. RALNP is a viable option in the treatment of symptomatic nephroptosis. Secure placement of several “pexing” sutures helps to ensure appropriate security of these itinerant kidneys. Our technique modification corrects kidney hypermobility while improving symptoms related to nephroptosis.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Bishoff JT, Kavoussi LR (2007) Laparoscopic surgery of the kidney. In: Wein AJ (ed) Campbell-Walsh urology, 9th edn, vol 2. Elsevier, Philadelphia, p 1776
Barber NJ, Thompson PM (2004) Nephroptosis and nephropexy–hung up on the past? Eur Urol 46(4):428–433. doi:10.1016/j.eururo.2004.03.023
McDougall EM, Afane JS, Dunn MD, Collyer WC, Clayman RV (2000) Laparoscopic nephropexy: long-term follow-up––Washington University experience. J Endourol 14(3):247–250
Strohmeyer DM, Peschel R, Effert P, Borchert O, Janetschek G, Bartsch G, Frauscher F (2004) Changes of renal blood flow in nephroptosis: assessment by color Doppler imaging, isotope renography and correlation with clinical outcome after laparoscopic nephropexy. Eur Urol 45(6):790–793. doi:10.1016/j.eururo.2003.12.011
Fornara P, Doehn C, Jocham D (1997) Laparoscopic nephropexy: 3-year experience. J Urol 158(5):1679–1683. doi:S0022-5347(01)64093-X
Nayyar R, Gupta NP, Hemal AK (2009) Robotic management of complicated ureteropelvic junction obstruction. World J Urol. doi:10.1007/s00345-009-0469-y
Boylu U, Lee BR, Thomas R (2009) Robotic-assisted laparoscopic pyeloplasty and nephropexy for ureteropelvic junction obstruction and nephroptosis. J Laparoendosc Adv Surg Tech A 19(3):379–382. doi:10.1089/lap.2008.0297
Partin AW, Adams JB, Moore RG, Kavoussi LR (1995) Complete robot-assisted laparoscopic urologic surgery: a preliminary report. J Am Coll Surg 181(6):552–557
Conflict of interest
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Castle, S.M., Karnjanawanichkul, W. & Leveillee, R.J. Application of “cinch/tie” technique to robotic-assisted nephropexy for posterior abdominal wall fixation. J Robotic Surg 6, 155–157 (2012). https://doi.org/10.1007/s11701-010-0237-4
- Robotic-assisted surgery