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An 10 mm trocar was fixed using open access technique through fascia from a Pfannenstiel incision, to be used for kidney extraction. Vascular clipping, suctioning, and bipolar coagulating can all be performed through this trocar. A 5mm trocar was used as a camera port and placed transumbilically under direct vision. Two 3.5mm trocars were placed above and lateral to the umbilicus and were used for grasping and scissoring, respectively.
The colon was mobilized medially and splenorenal and renocolic ligaments were dissected. The left ureter together with the gonadal vein was dissected free and upward while preserving peri-ureteral tissues. The renal vein was dissected distal to the gonadal vein and bipolar coagulation and division of lumbar and adrenal veins were preformed.
The adrenal gland was separated from the kidney using bipolar coagulation of small adrenal arteries under the adrenal gland. The rest of the kidney was dissected free from surrounding tissues. The renal artery and vein and the ureter were clipped through the suprapubic trocar using a Hem-o-Lok clip applier and titanium clip applier. The renal artery and vein and the ureter were divided and the kidney was hand extracted through the prepared suprapubic opening. Only the 5 mm camera port was closed, using monocryl sutures. The two 3.5 mm miniports were left unsutured.