Preoperative Assessment for Laparoscopic Simple Nephrectomy

Laparoscopic simple nephrectomies are performed for benign pathologic conditions involving the kidney. Most often, these entities result in problems such as pain, bleeding, hematuria, or chronic infection. In addition, some benign processes cause massive enlargement of the kidney, leading to displacement of adjacent structures and symptoms such as dyspnea, early satiety, and gastroesophageal reflux. Symptomatic indications include the following 2. Adult dominant polycystic kidney disease...

Adult Polycystic Kidney Disease

Laparoscopic cyst decortication has also been described for the management of symptomatic ADPKD. ADPKD is the most common renal cystic disease, accounting for 9-10 of patients on chronic dialysis (3). The disease typically presents in the third or fourth decade of life and is progressive in nature. Mutations in at least three genes thought to be responsible for the disease have been identified PKD-1, PKD-2, and PKD-3, with a mutation in the PKD-1 gene on the short arm of chromosome 16...

Laparoscopic Radical Cystectomy

A Foley catheter is placed in the bladder after the patient is prepped and draped. After port placement, cystoprostatetcomy is initiated by dissecting sigmoid and bowel adhesions from the pelvic side wall. A wide peritoneal incision is made beginning in the midline in the rectovesical pouch (Fig. 3). A plane is identified between the bladder and the rectum. The vasa deferentia are divided and dissection continued along the posterior aspect of the seminal vesicles toward the bladder base (Fig....

Laparoscopic Ileal Conduit

With the cystoprostatectomy and lymphadenectomy completed, attention is focused on the urinary diversion. In the case of the ileal conduit, a 15-20 cm segment of ileum is identified 15 cm from the ileocecal junction. Division of the isolated segment of bowel and the mesentery is performed using the Endo-GIA stapler (Fig. 7). Staple heights of 3.5 mm are used for the bowel and 2 or 2.5 mm for the mesentery. Two firings are used to complete the distal mesenteric division and one firing is used to...

Autosomal Dominant Polycystic Kidney Disease

Laparoscopic cyst decortication for ADPKD has been reported in a few small series (Table 4) (31,35-39,50). Although the early series do not note the number of cysts decorticated, several recent studies emphasize the importance of extensive cyst decortication. Dunn and co-workers marsupialized on average 204 cysts procedure with the hope that more aggressive cyst decortication may lead to more durable pain relief (38,50). It should be noted that extensive cyst decortication is a time-consuming...

Access Laparoscopic and Hand Assisted Laparoscopic Nephroureterectomy

Laparoscopic Nephroureterectomy

Laparoscopic access can be obtained via a direct vision (Hasson) or Veress needle technique. Templates for trocar positioning for both right and left renal access are presented in Figs. 2 and 3. In the virgin abdomen, the anterior superior iliac spine trocar site is used for primary access. Alternatively, if there has been prior surgery in the lower abdomen, the subcostal trocar site is suitable for primary access. A 12-mm incision is made approximately 2 fingerbreadths medial and cranial to...

Endoholder- Jarit

Laparoscopic Instrumentation for Laparoscopic Nephroureterectomy Endo-GIA stapler Vascular load Clip appliers 11-mm titanium clips Harmonic scalpel 5 mm curved jaws Ethicon a Endocatch II 15-mm entrapment sack Ethicon Others Trocars three 12-mm and one 5-mm Veress needles Gel Port Applied Medical Resources Nondisposable equipment End effectors Bipolar grasping forceps Aesculap a Suction irrigator, extra-long, 5-mm Nezhat system Storz 5-mm hook electrode Electroscope 5-mm and 10-mm PEER...

Laparoscopic Radical Nephrectomy

The peritoneal cavity is closely inspected. The liver is visualized for mass lesions. The outline of the kidney within Gerota's fascia is commonly visible behind the ascending colon. Step 1 Peritoneal Incisions and Pararenal Dissection. The key to en bloc resection of the kidney within Gerota's fascia lies in defining the borders of the dissection. On the right side, the dissection follows an anatomic template with a wedge-shaped configuration Fig. 6 . The apical edge of the wedge is the line...

Extended Lymph Node Dissection

Though obturator lymph node dissection is satisfactory for evaluation of prostate cancer, an extended lymph node dissection is usually required in cases of bladder, ure-thral, and penile cancer. An extended pelvic lymph node dissection may sometimes be carried out in patients with prostate cancer and negative obturator nodes that are highly suspected of having metastatic local disease such as in cases of clinical T3 disease and or markedly elevated PSA gt 60 11 . For extended pelvic...

Surgical Technique Laparoscopic and Hand Assisted Laparoscopic Nephroureterectomy

After gaining access, the peritoneal cavity is closely inspected, and the liver is visualized for mass lesions. With hand-assisted nephroureterectomy, palpation of abdominal structures is possible. The outline of the kidney within Gerota's fascia is commonly visible behind the ascending colon. Step 1 Peritoneal Incisions and Pararenal Dissection. The key to en bloc resection of the kidney within Gerota's fascia lies in defining the borders of the dissection. On the right side, the dissection...

Left Radical Nephrectomy

The investing tissue overlying the hilar vessels is grasped with the fingertips, retracted anteriorly, and a plane between these tissues and renal vein is developed using the Harmonic scalpel or scissors. Once the anterior wall of the renal vein is exposed, meticulous dissection allows identification of both the gonadal vein and left adrenal vein entering the renal vein. These veins are dissected free of their surrounding tissues and doubly clipped both proximally...