Since the advent of laparoscopy, there has been a desire to reduce the number of laparoscopic ports, as each port increases potential morbidity, while decreasing cosmetic outcome. In this video, we present the first ever single port access nephrectomy in a pediatric patient.

A 12 year old male was followed since age one for a multicystic, dysplastic left kidney, which demonstrated involution over the first seven years. However, follow-up showed increase in size over the next five years, from 6.2 cm in length to 8cm, with associated left flank pain and contralateral compensatory hypertrophy. MAG 3 renal scan revealed 100% split renal function of the right kidney and left nephrectomy was elected. With the patient in a right lateral decubitus position, a semicircular infraumbilical incision was made for single access port placement. Mobilization of the spleen and left colon allowed for identification of the left kidney and ureter. A harmonic scalpel was used to take the atretic renal artery, renal vein and ureter, and after complete mobilization of the left kidney, it was secured in an entrapment sac and removed through a single incision.

Operative time was 2.5 hours and blood loss was 50 cc. Hospital stay was 1 day. Pathology revealed multicystic renal dysplasia, with cysts from 0.4-1.9 cm. The procedure was performed through a single port in the umbilicus, making the abdominal incision, in essence, hidden.

Single port access nephrectomy in children is safe, effective and technically feasible. It is associated with improved cosmesis, short hospital stay and quick recovery.