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A simple kidney entrapment technique using a zipped plastic bag during retroperitoneoscopic radical nephrectomy

The reversed bag is folded longitudinally in a zigzag pattern, allowing it to unfold easily in the retroperitoneal space, then inserted through the first trocar site, base first and pushed cranially by a finger. The first 12-mm trocar is reinserted and a pneumoretroperitoneum created. Two grasping forceps are used to unfold and open the mouth of the bag. Because the plastic zipper welds at both ends, the inherent elasticity of the zipper helps to open the mouth of the reversed bag. After the bag is unfolded, the mouth of the bag opens toward the pelvis (Fig. 2). The opposite sides of the mouth of the bag can be recognized by different colours of zipper (blue and pinkpurple in Ziploc bags; blue and yellow in Glad bags). Two grasping forceps are used to push up the kidney into the bag. Because the mouth of the bag holds itself open during this manoeuvre, it is unnecessary to hold it with grasping forceps. However, it may be helpful to slide the lower lip of the bag underneath the upper pole of the kidney. After the specimen has been entrapped in the bag, a 5–7-cm pararectal skin incision is made. The mouth of the bag is grasped by several Kelly forceps and delivered through the incision. We have also used this technique in retroperitoneoscopic nephroureterectomy. Briefly, nephrectomy is performed retroperitoneoscopically in the standard flank position and the kidney entrapped into the bag is pushed to the pelvic end of the retroperitoneal space. The patient is then placed supine and a 5–6-cm pararectal incision made in the ipsilateral lower abdomen. The ureter is dissected extravesically and resected with a cuff of vesical mucosa, and the entire specimen is extracted en bloc .