Single-port laparoscopic nephrectomy

Evidence on the safety and efficacy of single-port laparoscopic nephrectomy is based on limited numbers of patients. Any advantage for patients of the procedure over conventional laparoscopic nephrectomy is uncertain and there is inadequate evidence on safety, including insufficient information about warm ischaemia time when used to harvest kidneys from live donors for transplantation. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

Clinicians wishing to undertake single-port laparoscopic nephrectomy should take the following actions.

• Inform the clinical governance leads in their Trusts.

• Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.

• Audit and review clinical outcomes of all patients having single-port laparoscopic nephrectomy (see section 3.1).

Patient selection is particularly important when the procedure is being considered for the treatment of patients with malignant disease.

Single-port laparoscopic nephrectomy is technically challenging and should only be carried out by experienced laparoscopic surgeons who have received specific training in the procedure.

NICE encourages the publication of further evidence on single-port laparoscopic nephrectomy. In particular, clinicians are encouraged to collect and publish data on long-term recurrence rates when the procedure is used to treat malignancy and on subsequent graft survival and renal function when it is used for donor nephrectomy. NICE may review the procedure on publication of further evidence.